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These complications can occur early in the postoperative period, or even months or years later (Gawande et al., 2003; Healthcare Insurance Reciprocal of Canada (HIROC), 2016; The Joint Commission, 2013).",{"type":15,"attrs":423,"content":424},{"textAlign":53},[425],{"text":426,"type":351},"The Organisation for Economic Co-operation and Development (OECD) reports for the year 2017 that the average rate for a foreign body left inside the patient's body during a procedure, per 100,000 medical and surgical discharges is 3.8, versus the Canadian rate of 9.8, which represents a 14 per cent increase over the last five years (Canadian Institute for Health Information (CIHI, 2019a and CIHI, 2019b). ",{"type":15,"attrs":428,"content":429},{"textAlign":53},[430],{"text":431,"type":351},"A 10-year review of medico-legal cases in Canada between 2004 and 2013 found that retained foreign bodies or wrong surgery were identified in 12 to 18 per cent of surgical incidents (Canadian Medical Protective Association (CMPA & HIROC, 2016).",{"type":383,"attrs":433,"content":434},{"level":413,"textAlign":53},[435],{"text":436,"type":351},"Retained foreign bodies can include:",{"type":438,"content":439},"bullet_list",[440,448,455,462],{"type":441,"content":442},"list_item",[443],{"type":15,"attrs":444,"content":445},{"textAlign":53},[446],{"text":447,"type":351},"Soft devices, such as sponges and towels",{"type":441,"content":449},[450],{"type":15,"attrs":451,"content":452},{"textAlign":53},[453],{"text":454,"type":351},"Small miscellaneous items, including unretrieved device components or fragments (such as broken parts of instruments), stapler components, parts of laparoscopic trocars, guidewires, catheters, and pieces of drains",{"type":441,"content":456},[457],{"type":15,"attrs":458,"content":459},{"textAlign":53},[460],{"text":461,"type":351},"Needles and other sharps",{"type":441,"content":463},[464],{"type":15,"attrs":465,"content":466},{"textAlign":53},[467],{"text":468,"type":351},"Instruments, most commonly malleable retractors",{"type":15,"attrs":470,"content":471},{"textAlign":53},[472],{"text":473,"type":351},"(The Joint Commission, 2013)",{"type":383,"attrs":475,"content":476},{"level":413,"textAlign":53},[477],{"text":478,"type":351},"The most common root causes of retained foreign objects reported to The Joint Commission are:",{"type":438,"content":480},[481,488,495,502,509,516],{"type":441,"content":482},[483],{"type":15,"attrs":484,"content":485},{"textAlign":53},[486],{"text":487,"type":351},"The absence of policies and procedures",{"type":441,"content":489},[490],{"type":15,"attrs":491,"content":492},{"textAlign":53},[493],{"text":494,"type":351},"Failure to comply with existing policies and procedures",{"type":441,"content":496},[497],{"type":15,"attrs":498,"content":499},{"textAlign":53},[500],{"text":501,"type":351},"Problems with hierarchy and intimidation",{"type":441,"content":503},[504],{"type":15,"attrs":505,"content":506},{"textAlign":53},[507],{"text":508,"type":351},"Failure in communication with physicians",{"type":441,"content":510},[511],{"type":15,"attrs":512,"content":513},{"textAlign":53},[514],{"text":515,"type":351},"Failure of staff to communicate relevant patient information",{"type":441,"content":517},[518],{"type":15,"attrs":519,"content":520},{"textAlign":53},[521],{"text":522,"type":351},"Inadequate or incomplete education of staff",{"type":15,"attrs":524,"content":525},{"textAlign":53},[526],{"text":473,"type":351},{"type":15,"attrs":528,"content":529},{"textAlign":53},[530],{"text":531,"type":351},"Traditional methods of preventing retained foreign bodies included \"cavity sweeps\" and manual counting protocols – both of which are prone to human error. Current practices for counting sponges have a 10 to 15 per cent error rate. In addition, 80 per cent of retained sponges occur with what staff believe is a correct count (The Joint Commission, 2013)",{"type":383,"attrs":533,"content":534},{"level":413,"textAlign":53},[535],{"text":536,"type":351},"Catheter shearing leading to retained foreign body",{"type":15,"attrs":538,"content":539},{"textAlign":53},[540],{"text":541,"type":351},"Most catheter procedures occur without complications however the insertion and removal of catheters can lead to retained foreign bodies when part of the catheter breaks off. Shearing typically occurs during insertion or removal of the catheter from patients. Catheter fragments remaining in patients can result in serious complications due to the location or migration of the fragment or inflammation at the fragment site. 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Puzzled radiologists told her there was a large medical instrument lodged inside her stomach (Gentile, 2017).",{"_uid":621,"title":622,"ctaLeft":623,"ctaRight":628,"component":603,"columnLeft":629,"columnRight":633},"fa0acb5f-6618-44b4-842f-287a65dc301a","Canada worse than other wealthy countries in patient safety – including objects left in body after surgery, data show",[624],{"_uid":625,"link":626,"label":600,"component":601},"795501df-2c34-4131-b4b7-6911852ffe1b",{"id":16,"url":627,"target":597,"linktype":598,"fieldtype":599,"cached_url":627},"https://www.theglobeandmail.com/life/health-and-fitness/article-canada-worse-than-other-wealthy-countries-in-patient-safety/",[],{"type":12,"content":630},[631],{"type":15,"attrs":632},{"textAlign":53},{"type":12,"content":634},[635],{"type":15,"attrs":636,"content":637},{"textAlign":53},[638],{"text":639,"type":351},"Canada is lagging other wealthy countries when it comes to patient safety, according to new data that show our country's hospitals record significantly higher rates of obstetrical trauma, as well as foreign objects, such as sponges and instruments, left in patients after surgery…. (Leung, 2019).","Importance to Patients and Families","accordion-2-columns",{"type":12,"content":643},[644],{"type":15,"attrs":645,"content":646},{"textAlign":53},[647],{"text":648,"type":351},"​Communication failures are common in the operating room and can lead to increased complications such as retained foreign bodies. Use of a surgical safety checklist may prevent communication failures and reduce complications. While the physical act of \"checking the box\" may not necessarily prevent all adverse events, the checklist is a scaffold on which attitudes towards teamwork and communication can be encouraged and improved. Compliance with the checklist includes communication with the patient and is critical for the effects on patient safety to be realized (Pugel et al., 2015).",{"_uid":650,"items":651,"title":765,"component":641,"description":766},"56ab3959-1b16-41e9-818d-10a351c10b24",[652],{"_uid":653,"title":654,"ctaLeft":655,"ctaRight":656,"component":603,"columnLeft":657,"columnRight":679},"610b88a1-8386-4bd1-868e-1ec5ba02ae49","Expand to see a full list of resources",[],[],{"type":12,"content":658},[659],{"type":15,"attrs":660,"content":661},{"textAlign":53},[662,664,671,673,678],{"text":663,"type":351},"To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for conducting chart audits and analysis methods are included in the ",{"text":665,"type":351,"marks":666},"Hospital Harm Improvement Resources Introduction",[667],{"type":398,"attrs":668},{"href":400,"uuid":401,"anchor":53,"custom":669,"target":403,"linktype":404,"story":670},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":672,"type":351},".",{"text":674,"type":351,"marks":675}," ",[676],{"type":677},"bold",{"text":674,"type":351},{"type":12,"content":680},[681,686],{"type":15,"attrs":682,"content":683},{"textAlign":53},[684],{"text":685,"type":351},"If your review reveals that your cases of retained foreign body are linked to specific processes or procedures, you may find these resources helpful:",{"type":438,"content":687},[688,695,702,709,716,723,730,737,744,751,758],{"type":441,"content":689},[690],{"type":15,"attrs":691,"content":692},{"textAlign":53},[693],{"text":694,"type":351},"Agency for Healthcare Research and Quality (AHRQ). https://www.ahrq.gov/",{"type":441,"content":696},[697],{"type":15,"attrs":698,"content":699},{"textAlign":53},[700],{"text":701,"type":351},"American College of Surgeons - Revised statement on the prevention of unintentionally retained surgical items after surgery (2016). http://bulletin.facs.org/2016/10/revised-statement-on-the-prevention-of-unintentionally-retained-surgical-items-after-surgery/#.WxVdN0xFyUl",{"type":441,"content":703},[704],{"type":15,"attrs":705,"content":706},{"textAlign":53},[707],{"text":708,"type":351},"Association of periOperative Registered Nurses (AORN). https://www.aorn.org/",{"type":441,"content":710},[711],{"type":15,"attrs":712,"content":713},{"textAlign":53},[714],{"text":715,"type":351},"Canadian Patient Safety Institute. Surgical Safety Checklist (2009)",{"type":441,"content":717},[718],{"type":15,"attrs":719,"content":720},{"textAlign":53},[721],{"text":722,"type":351},"Nothing Left Behind. www.nothingleftbehind.org",{"type":441,"content":724},[725],{"type":15,"attrs":726,"content":727},{"textAlign":53},[728],{"text":729,"type":351},"Pennsylvania Patient Safety Advisory. http://patientsafety.pa.gov/",{"type":441,"content":731},[732],{"type":15,"attrs":733,"content":734},{"textAlign":53},[735],{"text":736,"type":351},"Retained Surgical Items: Events and Guidelines Revisited (2017) http://patientsafety.pa.gov/ADVISORIES/Pages/201703_RSI.aspx",{"type":441,"content":738},[739],{"type":15,"attrs":740,"content":741},{"textAlign":53},[742],{"text":743,"type":351},"Epidural or Subarachnoid Catheter Shear (2009) http://patientsafety.pa.gov/ADVISORIES/Pages/200909_84.aspx",{"type":441,"content":745},[746],{"type":15,"attrs":747,"content":748},{"textAlign":53},[749],{"text":750,"type":351},"Plumer's Principles and Practice of InfusionTherapy. Text Book (Weinstein, S.M.; Hagle, M.E. 9th Edition.  2014).",{"type":441,"content":752},[753],{"type":15,"attrs":754,"content":755},{"textAlign":53},[756],{"text":757,"type":351},"The Joint Commission. Preventing unintended retained foreign objects. Sentinel Event Alert. Issue 51, 2013. Available at: https://www.jointcommission.org/assets/1/6/SEA_51_Retained foreign bodies_10_17_13_FINAL.pdf",{"type":441,"content":759},[760],{"type":15,"attrs":761,"content":762},{"textAlign":53},[763],{"text":764,"type":351},"World Health Organization - Safe Surgery. https://www.who.int/patientsafety/safesurgery/en/","Clinical and System Reviews, Incident Analyses",{"type":12,"content":767},[768,773,779],{"type":15,"attrs":769,"content":770},{"textAlign":53},[771],{"text":772,"type":351},"Given the broad range of potential causes of a retained foreign body, clinical and system reviews should be conducted to identify potential causes and determine appropriate recommendations.",{"type":15,"attrs":774,"content":776},{"textAlign":775},"left",[777],{"text":778,"type":351},"Occurrences of harm are often complex with many contributing factors. Organizations need to:",{"type":780,"attrs":781,"content":783},"ordered_list",{"order":782},1,[784,791,798,805],{"type":441,"content":785},[786],{"type":15,"attrs":787,"content":788},{"textAlign":53},[789],{"text":790,"type":351},"Measure and monitor the types and frequency of these occurrences.",{"type":441,"content":792},[793],{"type":15,"attrs":794,"content":795},{"textAlign":53},[796],{"text":797,"type":351},"Use appropriate analytical methods to understand the contributing factors.",{"type":441,"content":799},[800],{"type":15,"attrs":801,"content":802},{"textAlign":53},[803],{"text":804,"type":351},"Identify and implement solutions or interventions that are designed to prevent recurrence and reduce risk of harm.",{"type":441,"content":806},[807],{"type":15,"attrs":808,"content":809},{"textAlign":53},[810],{"text":811,"type":351},"Have mechanisms in place to mitigate consequences of harm when it occurs.",{"_uid":813,"items":814,"title":858,"component":859,"description":860},"be3b7a82-b7ec-4b53-a512-e4112073c052",[815,826,834,842,850],{"_uid":816,"image":817,"title":821,"component":822,"description":823},"5c88ef3c-3fd2-442e-b9cf-478a0643de91",{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":820,"is_external_url":285},119537678778928,"https://a-ca.storyblok.com/f/850807391887861/600x600/c301964117/checkmark-icon.png",{},"Whenever possible, use measures you are already collecting for other programs.","small-text-image-item",{"type":12,"content":824},[825],{"type":15},{"_uid":827,"image":828,"title":830,"component":822,"description":831},"498e534c-913a-4ac0-90da-3396951645da",{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":829,"is_external_url":285},{},"Evaluate your choice of measures in terms of the usefulness of the final results and the resources required to obtain them; try to maximize the former while minimizing the latter.",{"type":12,"content":832},[833],{"type":15},{"_uid":835,"image":836,"title":838,"component":822,"description":839},"458f36cf-6776-4902-a081-12df8c65ad9f",{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":837,"is_external_url":285},{},"Try to include both process and outcome measures in your measurement scheme.",{"type":12,"content":840},[841],{"type":15},{"_uid":843,"image":844,"title":846,"component":822,"description":847},"6c6d04c8-d218-424c-945d-1f645847d838",{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":845,"is_external_url":285},{},"You may use different measures or modify measures to make them more appropriate and/or useful to your particular setting. However, be aware that modifying measures may limit the comparability of your results to others.",{"type":12,"content":848},[849],{"type":15},{"_uid":851,"image":852,"title":854,"component":822,"description":855},"e130fcb1-7d15-415e-aba6-5da19d55c7fa",{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":853,"is_external_url":285},{},"Posting your measure results within your hospital is a great way to keep your teams motivated and aware of progress. Try to include measures that your team will find meaningful and exciting (IHI, 2012).",{"type":12,"content":856},[857],{"type":15},"Measures","small-text-image",{"type":12,"content":861},[862],{"type":15,"attrs":863,"content":864},{"textAlign":53},[865],{"text":866,"type":351},"​Vital to quality improvement is measurement, and this applies specifically to implementation of interventions. The chosen measures will help to determine whether an impact is being made (primary outcome), whether the intervention is actually being carried out (process measures), and whether any unintended consequences ensue (balancing measures).",{"_uid":868,"items":869,"title":890,"component":641,"description":891},"ed575e2d-c13a-4a32-9df1-afe3f84c8465",[870],{"_uid":871,"title":872,"ctaLeft":873,"ctaRight":874,"component":603,"columnLeft":875,"columnRight":879},"31df90e3-3c2a-448e-8c03-8cbb7c9f6e6f","Selection Criteria",[],[],{"type":12,"content":876},[877],{"type":15,"attrs":878},{"textAlign":53},{"type":12,"content":880},[881],{"type":15,"attrs":882,"content":883},{"textAlign":53},[884,888],{"text":885,"type":351,"marks":886},"T81.5 / T81.6: ",[887],{"type":677},{"text":889,"type":351},"Identified as diagnosis type (2)","Discharge Abstract Database",{"type":12,"content":892},[893,898],{"type":15,"attrs":894,"content":895},{"textAlign":53},[896],{"text":897,"type":351},"Discharge Abstract Database (DAD) Codes included in this clinical category: D24: Retained Foreign Body",{"type":15,"attrs":899,"content":900},{"textAlign":53},[901],{"text":902,"type":351},"Concept: Foreign object or substance unintentionally left in the body during a medical or surgical procedure",{"_uid":904,"items":905,"title":957,"component":641,"description":958},"42ac371a-afd2-4bc4-90ef-f04fd7c47843",[906,932],{"_uid":907,"title":908,"ctaLeft":909,"ctaRight":915,"component":603,"columnLeft":916,"columnRight":920},"1206198e-595d-425e-8728-addb2417da98","Surgical Instruments Management Program",[910],{"_uid":911,"link":912,"label":914,"component":601},"ece800c9-6cd5-455d-9e73-f0243a5f4d77",{"id":16,"url":913,"target":597,"linktype":598,"fieldtype":599,"cached_url":913},"https://accreditation.ca/surgical-instruments-management-program","Learn more",[],{"type":12,"content":917},[918],{"type":15,"attrs":919},{"textAlign":53},{"type":12,"content":921},[922,927],{"type":15,"attrs":923,"content":924},{"textAlign":53},[925],{"text":926,"type":351},"Hopital Charles LeMoyne, Quebec, 2009",{"type":15,"attrs":928,"content":929},{"textAlign":53},[930],{"text":931,"type":351},"The surgical instruments management program at Hôpital Chalres LeMoyne is effective and provides the highest level of safety. There is a well–established, efficient tracking system. All instruments are identified with a unique number. When trays are prepared, instruments are logged using a scanner system. Trays are then identified with a barcode. During surgery, all instruments and devices are logged in a computer databank referenced to the patient's name. This system makes it possible to identify every instrument used in a specific operation (Hôpital Charles LeMoyne, 2009).",{"_uid":933,"title":934,"ctaLeft":935,"ctaRight":945,"component":603,"columnLeft":946,"columnRight":950},"8d6634e1-93b3-4851-b7cc-a77b09e6f538","Surgical error inspires doctor to champion the safety of all patients",[936],{"_uid":937,"link":938,"label":914,"component":601},"b05eade3-5479-4581-a3f0-6ec8ac8db997",{"id":939,"url":16,"linktype":404,"fieldtype":599,"cached_url":940,"story":941},"5f3dab6a-c8fb-450d-97d6-957200cf07e0","resources/healthcare-provider-stories",{"name":942,"id":943,"uuid":939,"slug":944,"url":940,"full_slug":940,"_stopResolving":291},"Healthcare Provider Stories",113881390448419,"healthcare-provider-stories",[],{"type":12,"content":947},[948],{"type":15,"attrs":949},{"textAlign":53},{"type":12,"content":951},[952],{"type":15,"attrs":953,"content":954},{"textAlign":53},[955],{"text":956,"type":351},"Peter Pisters, [former] President and CEO of University Health Network also saw himself as the Chief Patient Safety Officer… a duty he takes very seriously, fuelled by the painful memory of a single surgical sponge left behind in one of his patients (CPSI, 2016b)","Success Stories",{"type":12,"content":959},[960],{"type":15,"attrs":961},{"textAlign":53},{"_uid":963,"items":964,"title":1064,"component":641,"description":1065},"d27e0ee6-d543-4ffe-ba19-0beac7b5077d",[965],{"_uid":966,"title":967,"ctaLeft":968,"ctaRight":969,"component":603,"columnLeft":970,"columnRight":974},"d1d27db9-bb85-49f3-bb9e-7342f7791eb1","Expand to see a full list of references",[],[],{"type":12,"content":971},[972],{"type":15,"attrs":973},{"textAlign":53},{"type":12,"content":975},[976,981,991,996,1001,1006,1011,1020,1030,1035,1044,1049,1054,1059],{"type":15,"attrs":977,"content":978},{"textAlign":53},[979],{"text":980,"type":351},"Canadian Institute for Health Information (CIHI). Canada continues to lag behind other OECD countries on measures of patient safety. Ottawa, ON: CIHI. 2019a. ",{"type":15,"attrs":982,"content":983},{"textAlign":53},[984,986],{"text":985,"type":351},"Canadian Institute for Health Information (CIHI). OECD Interactive Tool: International Comparisons. Published 2019b. ",{"text":987,"type":351,"marks":988},"http://www.cihi.ca/en/oecd-interactive-tool-international-comparisons-patient-safety",[989],{"type":398,"attrs":990},{"href":987,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":15,"attrs":992,"content":993},{"textAlign":53},[994],{"text":995,"type":351},"Canadian Medical Protective Association (CMPA), Healthcare Insurance Reciprocal of Canada (HIROC). Detailed Analysis. Surgical Safety in Canada: A 10-Year Review of CMPA and HIROC Medico-Legal Data. 2016. ",{"type":15,"attrs":997,"content":998},{"textAlign":53},[999],{"text":1000,"type":351},"Canadian Patient Safety Institute (CPSI). Retained Foreign Object. Published 2016. ",{"type":15,"attrs":1002,"content":1003},{"textAlign":53},[1004],{"text":1005,"type":351},"Canadian Patient Safety Institute (CPSI). Surgical error inspires doctor to champion the safety of all patients. Published 2016.",{"type":15,"attrs":1007,"content":1008},{"textAlign":53},[1009],{"text":1010,"type":351},"Gawande AA, Studdert DM, Orav EJ, Brennan TA, Zinner MJ. Risk Factors for Retained Instruments and Sponges after Surgery. N Engl J Med. 2003;348(3):229-235. doi:10.1056/NEJMsa021721.",{"type":15,"attrs":1012,"content":1013},{"textAlign":53},[1014,1016],{"text":1015,"type":351},"Gentile D. \"It felt like I had been stabbed,\" says patient left with 33-cm metal plate inside after surgery. CBC News. Published June 28, 2017. ",{"text":596,"type":351,"marks":1017},[1018],{"type":398,"attrs":1019},{"href":596,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":15,"attrs":1021,"content":1022},{"textAlign":53},[1023,1025],{"text":1024,"type":351},"Hôpital Charles LeMoyne. Leading Practices: Surgical Instruments Management Program. Ottawa, ON: Health Standards Organization; 2009. ",{"text":1026,"type":351,"marks":1027},"https://healthstandards.org/leading-practice/surgical-instruments-management-program/",[1028],{"type":398,"attrs":1029},{"href":1026,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":15,"attrs":1031,"content":1032},{"textAlign":53},[1033],{"text":1034,"type":351},"Institute for Healthcare Improvement (IHI). How-to Guide: Prevent Harm from High-Alert Medications. Cambridge, MA: Institute for Healthcare Improvement (IHI); 2012. ",{"type":15,"attrs":1036,"content":1037},{"textAlign":53},[1038,1040],{"text":1039,"type":351},"Leung W. Canada worse than other wealthy countries in patient safety – including objects left in body after surgery, data show. The Globe and Mail. Published November 7, 2019. ",{"text":627,"type":351,"marks":1041},[1042],{"type":398,"attrs":1043},{"href":627,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":15,"attrs":1045,"content":1046},{"textAlign":53},[1047],{"text":1048,"type":351},"Pennsylvania Patient Safety Authority. Epidural or Subarachnoid Catheter Shear. Pa Patient Saf Auth. 2009;6(3):84-86. ",{"type":15,"attrs":1050,"content":1051},{"textAlign":53},[1052],{"text":1053,"type":351},"Pugel AE, Simianu VV, Flum DR, Patchen Dellinger E. Use of the surgical safety checklist to improve communication and reduce complications. J Infect Public Health. 2015;8(3):219-225. doi:10.1016/j.jiph.2015.01.001",{"type":15,"attrs":1055,"content":1056},{"textAlign":53},[1057],{"text":1058,"type":351},"The Joint Commission. Preventing unintended retained foreign objects. Sentin Event Alert. 2013;(51). ",{"type":15,"attrs":1060,"content":1061},{"textAlign":53},[1062],{"text":1063,"type":351},"Weinstein SM, Hagle ME. Plumer's Principles and Practice of Infusion Therapy. Ninth. Philadelphia, PA: Lippincott Williams & Wilkins; 2014.","References",{"type":12,"content":1066},[1067],{"type":15},{"id":16,"_uid":1069,"items":1070,"component":1097},"5daed966-cc94-42ce-b27a-62b49a0a70b4",[1071],{"_uid":1072,"link":1073,"image":1084,"title":1088,"component":1089,"description":1090},"f6c78a9e-4f6a-45b8-bc79-ec2ceee3be6f",[1074],{"_uid":1075,"link":1076,"label":1082,"component":1083},"12f0bdd9-e669-4b10-bd38-8efcfa7b4d8e",{"id":1077,"url":16,"linktype":404,"fieldtype":599,"cached_url":1078,"story":1079},"e810da59-1dac-470d-a9fa-5791fc96027f","resources/topics/hospital-harm",{"name":1080,"id":1081,"uuid":1077,"slug":9,"url":1078,"full_slug":1078,"_stopResolving":291},"Hospital Harm",147250689243354,"See all resources","simple-link",{"id":1085,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1086,"copyright":16,"fieldtype":283,"meta_data":1087,"is_external_url":285},121293076058734,"https://a-ca.storyblok.com/f/850807391887861/2068x1484/1aea4e8fb2/senior-woman-holding-doctors-hand.webp",{},"Hospital Harm Resources","image-text-colored-item",{"type":12,"content":1091},[1092],{"type":15,"attrs":1093,"content":1094},{"textAlign":53},[1095],{"text":1096,"type":351},"Healthcare Excellence Canada has developed Hospital Harm Improvement Resources – a compilation of resources to support patient safety and improvement efforts.","image-text-colored",[129,150,136,122,143,115,157],[185,192,200],"hec-page-resource-single","retained-foreign-body","resources/retained-foreign-body",-18610,[],103604225865405,"9227ce22-0205-4bad-8c4f-b2b84d6464f9","2025-12-08T17:45:28.460Z",[],[1110],{"path":1111,"name":1112,"lang":305,"published":291},"ressources/retention-d-un-corps-etranger","Rétention d’un corps étranger",{"name":1114,"created_at":1115,"published_at":1116,"updated_at":1117,"id":1118,"uuid":1119,"content":1120,"slug":2019,"full_slug":2020,"sort_by_date":53,"position":2021,"tag_list":2022,"is_startpage":285,"parent_id":1105,"meta_data":53,"group_id":2023,"first_published_at":2024,"release_id":53,"lang":299,"path":53,"alternates":2025,"default_full_slug":2020,"translated_slugs":2026},"Electrolyte and Fluid Imbalance","2025-12-08T19:58:36.624Z","2026-03-16T18:13:16.688Z","2026-03-16T18:13:16.732Z",120972560962131,"ccf9018c-c139-4d2b-9dfc-d75c12b6e4db",{"new":285,"seo":1121,"_uid":331,"hero":1122,"type":174,"topics":1145,"Noindex":285,"content":1146,"audience":2017,"duration":16,"regional":2018,"component":1100},{"_uid":328,"title":16,"plugin":329,"og_image":16,"og_title":16,"description":16,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[1123],{"_uid":334,"image":1124,"title":1128,"format":1129,"component":343,"description":1132,"key_learning":1139,"prerequisite":1142},{"id":1125,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1126,"copyright":16,"fieldtype":283,"meta_data":1127,"is_external_url":285},121292076802669,"https://a-ca.storyblok.com/f/850807391887861/2216x1568/1ab891bd1c/frame-5.png",{},"Hospital Harm: Electrolyte and Fluid Imbalance",{"type":12,"content":1130},[1131],{"type":15},{"type":12,"content":1133},[1134],{"type":15,"attrs":1135,"content":1136},{"textAlign":53},[1137],{"text":1138,"type":351},"Many adult hospital inpatients require intravenous (IV) fluid therapy to prevent or correct problems with their fluid and/or electrolyte status. This may be because they cannot meet their normal needs through oral or enteral routes (related for example to swallowing problems or gastrointestinal dysfunction) or because they have unusual fluid and/or electrolyte deficits or demands caused by illness or injury (e.g., high gastrointestinal or renal losses).",{"type":12,"content":1140},[1141],{"type":15},{"type":12,"content":1143},[1144],{"type":15},[76],[1147,1160,1358,1428,1624,1658,1805,1837,1999],{"_uid":361,"link":1148,"image":1149,"title":365,"component":366,"media_type":367,"description":1151},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":283,"meta_data":1150},{},{"type":12,"content":1152},[1153,1158],{"type":15,"attrs":1154,"content":1155},{"textAlign":53},[1156],{"text":1157,"type":351},"Reduce the incidence of harm associated with electrolyte and fluid imbalance. ",{"type":15,"attrs":1159},{"textAlign":53},{"_uid":376,"content":1161,"component":585},[1162],{"_uid":379,"content":1163,"component":584},{"type":12,"content":1164},[1165,1169,1180,1185,1190,1195,1246,1251,1281,1286,1291,1328,1333,1338,1343,1348,1353],{"type":383,"attrs":1166,"content":1167},{"level":385,"textAlign":53},[1168],{"text":388,"type":351},{"type":15,"attrs":1170,"content":1171},{"textAlign":53},[1172,1173,1179],{"text":393,"type":351},{"text":395,"type":351,"marks":1174},[1175],{"type":398,"attrs":1176},{"href":400,"uuid":401,"anchor":53,"custom":1177,"target":403,"linktype":404,"story":1178},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":410,"type":351},{"type":15,"attrs":1181,"content":1182},{"textAlign":53},[1183],{"text":1184,"type":351},"Deciding on the optimal amount and composition of IV fluids and the best rate at which to administer them can be a difficult task. Decisions must be based on careful assessment of the patient's individual needs (National Institute for Health and Care Excellence (NICE) 2013).",{"type":15,"attrs":1186,"content":1187},{"textAlign":53},[1188],{"text":1189,"type":351},"Although mismanagement of fluid therapy is rarely reported as being responsible for patient harm, it is likely that as many as one in five patients who receive intravenous (IV) fluids and electrolytes suffer complications or morbidity due to their inappropriate administration. (National Institute for Health and Care Excellence (NICE) 2013/2017),",{"type":15,"attrs":1191,"content":1192},{"textAlign":53},[1193],{"text":1194,"type":351},"Potential complications of fluid and electrolyte therapy include:",{"type":438,"content":1196},[1197,1204,1211,1218,1225,1232,1239],{"type":441,"content":1198},[1199],{"type":15,"attrs":1200,"content":1201},{"textAlign":53},[1202],{"text":1203,"type":351},"hyponatremia,",{"type":441,"content":1205},[1206],{"type":15,"attrs":1207,"content":1208},{"textAlign":53},[1209],{"text":1210,"type":351},"hypernatremia ",{"type":441,"content":1212},[1213],{"type":15,"attrs":1214,"content":1215},{"textAlign":53},[1216],{"text":1217,"type":351},"hypokalemia",{"type":441,"content":1219},[1220],{"type":15,"attrs":1221,"content":1222},{"textAlign":53},[1223],{"text":1224,"type":351},"hyperkalemia",{"type":441,"content":1226},[1227],{"type":15,"attrs":1228,"content":1229},{"textAlign":53},[1230],{"text":1231,"type":351},"hyperchloraemic acidosis",{"type":441,"content":1233},[1234],{"type":15,"attrs":1235,"content":1236},{"textAlign":53},[1237],{"text":1238,"type":351},"volume overload",{"type":441,"content":1240},[1241],{"type":15,"attrs":1242,"content":1243},{"textAlign":53},[1244],{"text":1245,"type":351},"volume depletion (NICE 2013)",{"type":15,"attrs":1247,"content":1248},{"textAlign":53},[1249],{"text":1250,"type":351},"Hospitalized patients require intravenous (IV) fluid and electrolytes for one or more of the following reasons (the 4Rs):",{"type":438,"content":1252},[1253,1260,1267,1274],{"type":441,"content":1254},[1255],{"type":15,"attrs":1256,"content":1257},{"textAlign":53},[1258],{"text":1259,"type":351},"Fluid resuscitation ",{"type":441,"content":1261},[1262],{"type":15,"attrs":1263,"content":1264},{"textAlign":53},[1265],{"text":1266,"type":351},"Routine maintenance ",{"type":441,"content":1268},[1269],{"type":15,"attrs":1270,"content":1271},{"textAlign":53},[1272],{"text":1273,"type":351},"Replacement ",{"type":441,"content":1275},[1276],{"type":15,"attrs":1277,"content":1278},{"textAlign":53},[1279],{"text":1280,"type":351},"Redistribution (NICE 2013/2017)",{"type":15,"attrs":1282,"content":1283},{"textAlign":53},[1284],{"text":1285,"type":351},"Despite the almost ubiquitous need for, and use of intravenous fluids in acutely ill patients, there has been little consensus on the most appropriate rate of administration and composition of intravenous fluids, and practice patterns with respect to maintenance fluids vary widely (Moritz & Ayus 2015).",{"type":15,"attrs":1287,"content":1288},{"textAlign":53},[1289],{"text":1290,"type":351},"According to NICE (2013/2017) the principles underpinning safe and effective IV fluid and electrolyte therapy are: ",{"type":438,"content":1292},[1293,1300,1307,1314,1321],{"type":441,"content":1294},[1295],{"type":15,"attrs":1296,"content":1297},{"textAlign":53},[1298],{"text":1299,"type":351},"physiological principles that underpin fluid prescribing",{"type":441,"content":1301},[1302],{"type":15,"attrs":1303,"content":1304},{"textAlign":53},[1305],{"text":1306,"type":351},"pathophysiological changes that affect fluid balance in disease states",{"type":441,"content":1308},[1309],{"type":15,"attrs":1310,"content":1311},{"textAlign":53},[1312],{"text":1313,"type":351},"indications for IV fluid therapy",{"type":441,"content":1315},[1316],{"type":15,"attrs":1317,"content":1318},{"textAlign":53},[1319],{"text":1320,"type":351},"reasons for the choice of the various fluids available and",{"type":441,"content":1322},[1323],{"type":15,"attrs":1324,"content":1325},{"textAlign":53},[1326],{"text":1327,"type":351},"principles of assessing fluid balance",{"type":383,"attrs":1329,"content":1330},{"level":413,"textAlign":53},[1331],{"text":1332,"type":351},"Fluid overload",{"type":15,"attrs":1334,"content":1335},{"textAlign":53},[1336],{"text":1337,"type":351},"Fluid overload is a relatively frequent occurrence in critically ill patients and is often a consequence of critical care intervention. It may lead to pulmonary edema and in critically ill patients, fluid overload is independently associated with increased morbidity and mortality as well as increased hospital costs (NICE 2013; Ogbu et al. 2015).",{"type":383,"attrs":1339,"content":1340},{"level":413,"textAlign":53},[1341],{"text":1342,"type":351},"Transfusion-associated circulatory overload (TACO)",{"type":15,"attrs":1344,"content":1345},{"textAlign":53},[1346],{"text":1347,"type":351},"TACO is a complication of blood transfusion that is due to impaired cardiac function and/or an excessively rapid rate of transfusion. It occurs in one in 700 transfusion recipients and patients over 70 years of age, infants, and patients with severe euvolemic anemia (hemoglobin \u003C50 g/L), renal impairment, fluid overload, and cardiac dysfunction are particularly susceptible (Callum et al. 2016). The risk factors for TACO include, age over 70 years, history of heart failure, left ventricular dysfunction, history of myocardial infarction, renal dysfunction, and positive fluid balance.  The clinical presentation includes: dyspnea, orthopnea, cyanosis, tachycardia, increased venous pressure and hypertension (Callum et al. 2016).",{"type":383,"attrs":1349,"content":1350},{"level":413,"textAlign":53},[1351],{"text":1352,"type":351},"Hypovolemic shock",{"type":15,"attrs":1354,"content":1355},{"textAlign":53},[1356],{"text":1357,"type":351},"In hypovolemia, a patient's fluid needs are not met by oral, enteral or IV intake and the patient will demonstrate features of dehydration on clinical exam, low urine output or concentrated urine and biochemical indicators, such as more than 50 per cent increase in urea or creatinine with no other identifiable cause (NICE, 2013). Patients may exhibit thirst, vomiting, diarrhea, weight loss, dizziness, confusion, somnolence, reduced skin turgor, dry mucous membranes, sunken eyes, reduced capillary refill, tachycardia and postural hypotension (Frost 2015). Hypovolemic shock is an emergency condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body.",{"_uid":1359,"content":1360,"component":585},"2b3dce56-63dc-4fd8-bc67-0a39ac6cbfb7",[1361],{"_uid":1362,"content":1363,"component":584},"32d0ac83-1a8e-428e-b5eb-bff8e0da107f",{"type":12,"content":1364},[1365,1369,1374,1379,1384,1397,1410],{"type":383,"attrs":1366,"content":1367},{"level":385,"textAlign":53},[1368],{"text":640,"type":351},{"type":15,"attrs":1370,"content":1371},{"textAlign":53},[1372],{"text":1373,"type":351},"Fluid and electrolyte imbalances are associated with numerous complications, including increased morbidity and mortality, as well as increased hospital length of stay. Hospital patients needing IV fluids are very variable in terms of their fluid and electrolyte status and their likely responses to IV fluid therapy. Therefore, a full assessment is required by a competent clinician regarding the best content, volume and rate of IV fluids to be administered in order to minimize risks associated with fluid and electrolyte therapy (NICE 2013).",{"type":15,"attrs":1375,"content":1376},{"textAlign":53},[1377],{"text":1378,"type":351},"Patients have a valuable contribution to make to their fluid balance. If a patient needs IV fluids, the decision should be explained to them along with the signs and symptoms they need to look for if their fluid balance needs adjusting. If possible or when asked, provide written information (for example, NICE's Information for the public), and involve the patient's family members or carers (as appropriate) (NICE 2013).",{"type":383,"attrs":1380,"content":1381},{"level":413,"textAlign":53},[1382],{"text":1383,"type":351},"Patient Stories",{"type":15,"attrs":1385,"content":1386},{"textAlign":53},[1387,1395],{"text":1388,"type":351,"marks":1389},"Near Fatal: A Patient Safety Story",[1390,1394],{"type":398,"attrs":1391},{"href":1392,"uuid":53,"anchor":53,"custom":1393,"target":597,"linktype":598},"https://www.youtube.com/watch?v=pcQUnGiuhzM",{},{"type":677},{"text":1396,"type":351}," (Saskatchewan Health Authority - Saskatoon area, 2015)",{"type":15,"attrs":1398,"content":1399},{"textAlign":53},[1400,1402,1408],{"text":1401,"type":351},"Medication Error in the Hospital Kills Two-Year Old Emily Jerry. ",{"text":1403,"type":351,"marks":1404},"As told by Christopher S. Jerry",[1405],{"type":398,"attrs":1406},{"href":1407,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},"https://psmf.org/story/emily-jerry/",{"text":1409,"type":351}," (Patient Safety Movement, 2014)",{"type":15,"attrs":1411,"content":1412},{"textAlign":53},[1413,1418,1420,1427],{"text":1414,"type":351,"marks":1415},"Emily Jerry was diagnosed with a yolk sac tumor about the size of a grapefruit when she was about 18 months old. Her doctors and nurses assured me that Emily's cancer was not only treatable, but curable…Sunday, Feb. 26, after the third day of her last chemotherapy treatment, Emily awoke from her nap groggy. She kept trying to sit up and asked her mom to hold her in her lap. She kept grabbing her head and moaning that it hurt…. She cried some more before she started screaming, \"Mommy, my head, my head hurts! MY HEAD HURTS!\"…Emily went completely limp and the nurses began to resuscitate her. Within the hour, my precious daughter was on life support.  Emily wound up brain dead and on life support – essentially dead due to the massive brain damage she had incurred. Our Emily was killed by an overdose of sodium chloride in her chemotherapy IV bag",[1416],{"type":1417},"italic",{"text":1419,"type":351},"…..read the full story ",{"text":1421,"type":351,"marks":1422},"here",[1423],{"type":398,"attrs":1424},{"href":1425,"uuid":53,"anchor":53,"custom":1426,"target":597,"linktype":598},"https://patientsafetymovement.org/advocacy/patients-and-families/patient-stories/emily-jerry/",{},{"text":672,"type":351},{"_uid":650,"items":1429,"title":765,"component":641,"description":1584},[1430],{"_uid":653,"title":654,"ctaLeft":1431,"ctaRight":1432,"component":603,"columnLeft":1433,"columnRight":1437},[],[],{"type":12,"content":1434},[1435],{"type":15,"attrs":1436},{"textAlign":53},{"type":12,"content":1438},[1439,1451,1456],{"type":15,"attrs":1440,"content":1441},{"textAlign":53},[1442,1443,1449],{"text":663,"type":351},{"text":665,"type":351,"marks":1444},[1445],{"type":398,"attrs":1446},{"href":400,"uuid":401,"anchor":53,"custom":1447,"target":403,"linktype":404,"story":1448},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":1450,"type":351},". ",{"type":15,"attrs":1452,"content":1453},{"textAlign":53},[1454],{"text":1455,"type":351},"If your review reveals that your cases of fluid and electrolyte imbalance are linked to specific processes or procedures, you may find these resources helpful:",{"type":438,"content":1457},[1458,1496,1534,1572],{"type":441,"content":1459},[1460,1470],{"type":15,"attrs":1461,"content":1462},{"textAlign":53},[1463],{"text":1464,"type":351,"marks":1465},"Institute for Healthcare Improvement (IHI)",[1466],{"type":398,"attrs":1467},{"href":1468,"uuid":53,"anchor":53,"custom":1469,"target":597,"linktype":598},"http://www.ihi.org/",{},{"type":438,"content":1471},[1472,1484],{"type":441,"content":1473},[1474],{"type":15,"attrs":1475,"content":1476},{"textAlign":53},[1477],{"text":1478,"type":351,"marks":1479},"Reduce Adverse Drug Events Involving Electrolytes",[1480],{"type":398,"attrs":1481},{"href":1482,"uuid":53,"anchor":53,"custom":1483,"target":597,"linktype":598},"http://www.ihi.org/resources/Pages/Changes/ReduceAdverseDrugEventsInvolvingElectrolytes.aspx",{},{"type":441,"content":1485},[1486],{"type":15,"attrs":1487,"content":1488},{"textAlign":53},[1489],{"text":1490,"type":351,"marks":1491},"How- to guide: prevent harm from high-alert medications. 2012",[1492],{"type":398,"attrs":1493},{"href":1494,"uuid":53,"anchor":53,"custom":1495,"target":597,"linktype":598},"http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventHarmfromHighAlertMedications.aspx",{},{"type":441,"content":1497},[1498,1508],{"type":15,"attrs":1499,"content":1500},{"textAlign":53},[1501],{"text":1502,"type":351,"marks":1503},"Institute for Safe Medication Practice",[1504],{"type":398,"attrs":1505},{"href":1506,"uuid":53,"anchor":53,"custom":1507,"target":597,"linktype":598},"https://www.ismp.org/",{},{"type":438,"content":1509},[1510,1522],{"type":441,"content":1511},[1512],{"type":15,"attrs":1513,"content":1514},{"textAlign":53},[1515],{"text":1516,"type":351,"marks":1517},"Targeted Medication Safety Best Practices for Hospitals. ",[1518],{"type":398,"attrs":1519},{"href":1520,"uuid":53,"anchor":53,"custom":1521,"target":597,"linktype":598},"https://www.ismp.org/guidelines/best-practices-hospitals",{},{"type":441,"content":1523},[1524],{"type":15,"attrs":1525,"content":1526},{"textAlign":53},[1527],{"text":1528,"type":351,"marks":1529},"High-Alert Medications in Acute Care Settings.",[1530],{"type":398,"attrs":1531},{"href":1532,"uuid":53,"anchor":53,"custom":1533,"target":597,"linktype":598},"https://www.ismp.org/recommendations/high-alert-medications-acute-list",{},{"type":441,"content":1535},[1536,1546],{"type":15,"attrs":1537,"content":1538},{"textAlign":53},[1539],{"text":1540,"type":351,"marks":1541},"National Institute for Health and Care Excellence (NICE) ",[1542],{"type":398,"attrs":1543},{"href":1544,"uuid":53,"anchor":53,"custom":1545,"target":597,"linktype":598},"https://www.nice.org.uk/",{},{"type":438,"content":1547},[1548,1560],{"type":441,"content":1549},[1550],{"type":15,"attrs":1551,"content":1552},{"textAlign":53},[1553],{"text":1554,"type":351,"marks":1555},"Intravenous fluid therapy in adults in hospital: Clinical guideline [CG174] ",[1556],{"type":398,"attrs":1557},{"href":1558,"uuid":53,"anchor":53,"custom":1559,"target":597,"linktype":598},"https://www.nice.org.uk/guidance/cg174",{},{"type":441,"content":1561},[1562],{"type":15,"attrs":1563,"content":1564},{"textAlign":53},[1565],{"text":1566,"type":351,"marks":1567},"Intravenous fluid therapy in adults in hospital: Quality standard [QS66]",[1568],{"type":398,"attrs":1569},{"href":1570,"uuid":53,"anchor":53,"custom":1571,"target":597,"linktype":598},"https://www.nice.org.uk/guidance/qs66",{},{"type":441,"content":1573},[1574],{"type":15,"attrs":1575,"content":1576},{"textAlign":53},[1577],{"text":1578,"type":351,"marks":1579},"Ontario Regional Blood Coordinating Network: Bloody Easy for Healthcare Professionals.",[1580],{"type":398,"attrs":1581},{"href":1582,"uuid":53,"anchor":53,"custom":1583,"target":597,"linktype":598},"https://transfusionontario.org/en/category/bloody-easy-e-tools-publications/",{},{"type":12,"content":1585},[1586,1591,1595,1622],{"type":15,"attrs":1587,"content":1588},{"textAlign":53},[1589],{"text":1590,"type":351},"Given the broad range of potential causes of Electrolyte and Fluid Imbalance, in addition to recommendations listed above, we recommend conducting clinical and system reviews to identify latent causes and determine appropriate recommendations.",{"type":15,"attrs":1592,"content":1593},{"textAlign":775},[1594],{"text":778,"type":351},{"type":780,"attrs":1596,"content":1597},{"order":782},[1598,1604,1610,1616],{"type":441,"content":1599},[1600],{"type":15,"attrs":1601,"content":1602},{"textAlign":53},[1603],{"text":790,"type":351},{"type":441,"content":1605},[1606],{"type":15,"attrs":1607,"content":1608},{"textAlign":53},[1609],{"text":797,"type":351},{"type":441,"content":1611},[1612],{"type":15,"attrs":1613,"content":1614},{"textAlign":53},[1615],{"text":804,"type":351},{"type":441,"content":1617},[1618],{"type":15,"attrs":1619,"content":1620},{"textAlign":53},[1621],{"text":811,"type":351},{"type":15,"attrs":1623},{"textAlign":775},{"_uid":813,"items":1625,"title":858,"component":859,"description":1651},[1626,1633,1639,1645],{"_uid":835,"image":1627,"title":1629,"component":822,"description":1630},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":1628,"is_external_url":285},{},"You may use different measures or modify the measures described below to make them more appropriate and/or useful to your particular setting. However, be aware that modifying measures may limit the comparability of your results to others.",{"type":12,"content":1631},[1632],{"type":15},{"_uid":827,"image":1634,"title":830,"component":822,"description":1636},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":1635,"is_external_url":285},{},{"type":12,"content":1637},[1638],{"type":15},{"_uid":816,"image":1640,"title":821,"component":822,"description":1642},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":1641,"is_external_url":285},{},{"type":12,"content":1643},[1644],{"type":15},{"_uid":843,"image":1646,"title":838,"component":822,"description":1648},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":1647,"is_external_url":285},{},{"type":12,"content":1649},[1650],{"type":15},{"type":12,"content":1652},[1653],{"type":15,"attrs":1654,"content":1655},{"textAlign":53},[1656],{"text":1657,"type":351},"Vital to quality improvement is measurement, and this applies specifically to implementation of interventions. The chosen measures will help to determine whether an impact is being made (primary outcome), whether the intervention is actually being carried out (process measures), and whether any unintended consequences ensue (balancing measures). In selecting your measures, consider the following:",{"_uid":868,"items":1659,"title":890,"component":641,"description":1784},[1660,1696,1742],{"_uid":871,"title":872,"ctaLeft":1661,"ctaRight":1662,"component":603,"columnLeft":1663,"columnRight":1667},[],[],{"type":12,"content":1664},[1665],{"type":15,"attrs":1666},{"textAlign":53},{"type":12,"content":1668},[1669,1678,1687],{"type":15,"attrs":1670,"content":1671},{"textAlign":53},[1672,1676],{"text":1673,"type":351,"marks":1674},"E86.–  E87.–",[1675],{"type":677},{"text":1677,"type":351},": Identified as diagnosis type (2)",{"type":15,"attrs":1679,"content":1680},{"textAlign":53},[1681,1685],{"text":1682,"type":351,"marks":1683},"E87.7",[1684],{"type":677},{"text":1686,"type":351},": Identified as diagnosis type (3) AND T80.8 as diagnosis type (2) AND Y60–Y84  in the same diagnosis cluster",{"type":15,"attrs":1688,"content":1689},{"textAlign":53},[1690,1694],{"text":1691,"type":351,"marks":1692},"R57.1",[1693],{"type":677},{"text":1695,"type":351},": Identified as diagnosis type (2) not in a diagnosis cluster",{"_uid":1697,"title":1698,"ctaLeft":1699,"ctaRight":1700,"component":603,"columnLeft":1701,"columnRight":1705},"b9b8c1e0-53ae-4f62-8dc7-54e61e464643","Codes & Code Descriptions",[],[],{"type":12,"content":1702},[1703],{"type":15,"attrs":1704},{"textAlign":53},{"type":12,"content":1706},[1707,1716,1725,1734],{"type":15,"attrs":1708,"content":1709},{"textAlign":53},[1710,1714],{"text":1711,"type":351,"marks":1712},"E86.–",[1713],{"type":677},{"text":1715,"type":351}," : Volume depletion",{"type":15,"attrs":1717,"content":1718},{"textAlign":53},[1719,1723],{"text":1720,"type":351,"marks":1721},"E87.–",[1722],{"type":677},{"text":1724,"type":351}," : Other disorders of fluid, electrolyte and acid–base balance",{"type":15,"attrs":1726,"content":1727},{"textAlign":53},[1728,1732],{"text":1729,"type":351,"marks":1730},"E87.7 ",[1731],{"type":677},{"text":1733,"type":351},": Fluid overload",{"type":15,"attrs":1735,"content":1736},{"textAlign":53},[1737,1740],{"text":1691,"type":351,"marks":1738},[1739],{"type":677},{"text":1741,"type":351}," : Hypovolemic shock",{"_uid":1743,"title":1744,"ctaLeft":1745,"ctaRight":1746,"component":603,"columnLeft":1747,"columnRight":1751},"298700c3-a866-4c7b-9c20-e87c98c04dea","Additional codes & Inclusions",[],[],{"type":12,"content":1748},[1749],{"type":15,"attrs":1750},{"textAlign":53},{"type":12,"content":1752},[1753,1768],{"type":15,"attrs":1754,"content":1755},{"textAlign":53},[1756,1760,1762,1766],{"text":1757,"type":351,"marks":1758},"T80.8",[1759],{"type":677},{"text":1761,"type":351},":",{"text":1763,"type":351,"marks":1764}," ",[1765],{"type":677},{"text":1767,"type":351},"Other complications following infusion, transfusion and therapeutic injection",{"type":15,"attrs":1769,"content":1770},{"textAlign":53},[1771,1775,1777],{"text":1772,"type":351,"marks":1773},"Y60-Y84: ",[1774],{"type":677},{"text":1776,"type":351},"Complications of medical and surgical care (refer to Appendix A) of the ",{"text":1778,"type":351,"marks":1779},"Hospital Harm Indicator General Methodology Notes",[1780],{"type":398,"attrs":1781},{"href":1782,"uuid":53,"anchor":53,"custom":1783,"target":403,"linktype":598},"http://indicatorlibrary.cihi.ca/download/attachments/10453027/Hospital%20Harm%20Indicator%20General%20Methodology%20Notes.pdf?version=1&modificationDate=1561404418000&api=v2",{},{"type":12,"content":1785},[1786,1795,1800],{"type":15,"attrs":1787,"content":1788},{"textAlign":53},[1789,1791],{"text":1790,"type":351},"Discharge Abstract Database (DAD) Codes included in this clinical category: ",{"text":1792,"type":351,"marks":1793},"A09: Electrolyte and Fluid Imbalance",[1794],{"type":677},{"type":15,"attrs":1796,"content":1797},{"textAlign":53},[1798],{"text":1799,"type":351},"Concept: Electrolyte, fluid or acid–base imbalance identified during a hospital stay",{"type":15,"attrs":1801,"content":1802},{"textAlign":53},[1803],{"text":1804,"type":351},"Notes: This clinical group excludes procedure-associated hypovolemic shock (refer to D25: Post-Procedural Shock)",{"_uid":1806,"content":1807,"component":585},"4c9a9cb9-d213-40be-8404-e440ffe95625",[1808],{"_uid":1809,"content":1810,"component":584},"b7061b82-c9db-4f0d-a69d-f24df22e145e",{"type":12,"content":1811},[1812,1816,1827,1832],{"type":383,"attrs":1813,"content":1814},{"level":385,"textAlign":53},[1815],{"text":957,"type":351},{"type":383,"attrs":1817,"content":1818},{"level":413,"textAlign":53},[1819],{"text":1820,"type":351,"marks":1821},"St. Paul's Hospital, Vancouver BC",[1822,1826],{"type":398,"attrs":1823},{"href":1824,"uuid":53,"anchor":53,"custom":1825,"target":597,"linktype":598},"http://www.bcmj.org/articles/quality-improvement-project-enhance-management-hyperkalemia-hospitalized-patients","[object Object]",{"type":677},{"type":15,"attrs":1828,"content":1829},{"textAlign":53},[1830],{"text":1831,"type":351},"Physicians at St. Paul's Hospital in Vancouver recognized that hyperkalemia occurs in up to 10 per cent of hospitalized patients, and that although it is a life-threatening condition, there is little consistency in the management of high serum potassium. They conducted a quality improvement project aimed at increasing the proportion of hy­perkalemia cases managed according to the best available evidence and reducing the cost of treatment. A pocket-sized guideline outlining the management of hyperkalemia according to the best available evidence was distributed to in­ternal medicine residents. Cases of hyperkalemia occurring in a two-week period before the guideline was distributed (observational phase) were reviewed retrospectively and compared with cases occurring in two 2-week periods after the guideline was distributed (intervention phase). A review of paper charts and electronic health records indicated that before the intervention, hyperkalemia was managed according to the best available evidence in 63 per cent of cases. After the intervention, cases were managed according to the best available evidence in 94 per cent of cases. In addition, the overall cost incurred per case declined from $16.74 to $7.51.",{"type":15,"attrs":1833,"content":1834},{"textAlign":53},[1835],{"text":1836,"type":351},"In summary, providing residents with a user-friendly guideline for hyperkalemia increased the proportion of cases managed according to best available evidence and significantly reduced the cost associated with treatment. (Rajan et al. 2012)",{"_uid":963,"items":1838,"title":1064,"component":641,"description":1996},[1839],{"_uid":966,"title":967,"ctaLeft":1840,"ctaRight":1841,"component":603,"columnLeft":1842,"columnRight":1846},[],[],{"type":12,"content":1843},[1844],{"type":15,"attrs":1845},{"textAlign":53},{"type":12,"content":1847},[1848],{"type":438,"content":1849},[1850,1865,1881,1895,1911,1925,1940,1955,1969,1984],{"type":441,"content":1851},[1852,1863],{"type":15,"attrs":1853,"content":1854},{"textAlign":53},[1855,1857],{"text":1856,"type":351},"Callum JL, Pinkerton PH, Lima A, et al. Bloody Easy 4: Blood Transfusions, Blood Alternatives and Transfusion Reactions, A Guide to Transfusion Medicine. Fourth Edition. Ontario Regional Blood Coordinating Network; 2016. ",{"text":1858,"type":351,"marks":1859},"https://transfusionontario.org/en/download/bloody-easy-4-blood-transfusions-blood-alternatives-and-transfusion-reactions-a-guide-to-transfusion-medicine-fourth-edition/",[1860],{"type":398,"attrs":1861},{"href":1858,"uuid":53,"anchor":53,"custom":1862,"target":597,"linktype":598},{},{"type":15,"attrs":1864},{"textAlign":53},{"type":441,"content":1866},[1867,1879],{"type":15,"attrs":1868,"content":1869},{"textAlign":53},[1870,1872],{"text":1871,"type":351},"Frost P. Intravenous fluid therapy in adult inpatients. BMJ. 2015;350:g7620. doi:",{"text":1873,"type":351,"marks":1874},"10.1136/bmj.g7620",[1875],{"type":398,"attrs":1876},{"href":1877,"uuid":53,"anchor":53,"custom":1878,"target":597,"linktype":598},"https://www.bmj.com/content/350/bmj.g7620",{},{"type":15,"attrs":1880},{"textAlign":53},{"type":441,"content":1882},[1883,1893],{"type":15,"attrs":1884,"content":1885},{"textAlign":53},[1886,1888],{"text":1887,"type":351},"Institute for Healthcare Improvement (IHI). How-to Guide: Prevent Harm from High-Alert Medications. Cambridge, MA: IHI; 2012. ",{"text":1494,"type":351,"marks":1889},[1890],{"type":398,"attrs":1891},{"href":1494,"uuid":53,"anchor":53,"custom":1892,"target":597,"linktype":598},{},{"type":15,"attrs":1894},{"textAlign":53},{"type":441,"content":1896},[1897,1909],{"type":15,"attrs":1898,"content":1899},{"textAlign":53},[1900,1902],{"text":1901,"type":351},"Moritz ML, Ayus JC. Maintenance Intravenous Fluids in Acutely Ill Patients. N Engl J Med. 2015;373(14):1350-1360. doi:",{"text":1903,"type":351,"marks":1904},"10.1056/NEJMra1412877",[1905],{"type":398,"attrs":1906},{"href":1907,"uuid":53,"anchor":53,"custom":1908,"target":597,"linktype":598},"https://doi.org/10.1056/NEJMra1412877",{},{"type":15,"attrs":1910},{"textAlign":53},{"type":441,"content":1912},[1913,1923],{"type":15,"attrs":1914,"content":1915},{"textAlign":53},[1916,1918],{"text":1917,"type":351},"National Institute for Health and Care Excellence (NICE). Intravenous Fluid Therapy: Intravenous Fluid Therapy in Adults in Hospital. London, UK: NICE; 2013/Updated 2017. ",{"text":1558,"type":351,"marks":1919},[1920],{"type":398,"attrs":1921},{"href":1558,"uuid":53,"anchor":53,"custom":1922,"target":597,"linktype":598},{},{"type":15,"attrs":1924},{"textAlign":53},{"type":441,"content":1926},[1927,1938],{"type":15,"attrs":1928,"content":1929},{"textAlign":53},[1930,1932],{"text":1931,"type":351},"National Institute for Health and Care Excellence (NICE). Intravenous Fluid Therapy: Intravenous Fluid Therapy in Adults in Hospital. London, UK: NICE; 2013. ",{"text":1933,"type":351,"marks":1934},"https://www.nice.org.uk/guidance/cg174/evidence/full-guideline-pdf-191667999",[1935],{"type":398,"attrs":1936},{"href":1933,"uuid":53,"anchor":53,"custom":1937,"target":597,"linktype":598},{},{"type":15,"attrs":1939},{"textAlign":53},{"type":441,"content":1941},[1942,1953],{"type":15,"attrs":1943,"content":1944},{"textAlign":53},[1945,1947],{"text":1946,"type":351},"Ogbu OC, Murphy DJ, Martin GS. How to avoid fluid overload. Curr Opin Crit Care. 2015;21(4). ",{"text":1948,"type":351,"marks":1949},"https://journals.lww.com/co-criticalcare/Fulltext/2015/08000/How_to_avoid_fluid_overload.8.aspx",[1950],{"type":398,"attrs":1951},{"href":1948,"uuid":53,"anchor":53,"custom":1952,"target":597,"linktype":598},{},{"type":15,"attrs":1954},{"textAlign":53},{"type":441,"content":1956},[1957,1967],{"type":15,"attrs":1958,"content":1959},{"textAlign":53},[1960,1962],{"text":1961,"type":351},"Patient Safety Movement. Medication Error in the Hospital Kills Two-Year Old Emily Jerry. 2014. ",{"text":1425,"type":351,"marks":1963},[1964],{"type":398,"attrs":1965},{"href":1425,"uuid":53,"anchor":53,"custom":1966,"target":597,"linktype":598},{},{"type":15,"attrs":1968},{"textAlign":53},{"type":441,"content":1970},[1971,1982],{"type":15,"attrs":1972,"content":1973},{"textAlign":53},[1974,1976],{"text":1975,"type":351},"Rajan T, Widmer N, Kim H, Dehghan N, Alsahafi M, Levin A. A quality improvement project to enhance the management of hyperkalemia in hospitalized patients. B C Med J. 2012;54(1):29-33. ",{"text":1977,"type":351,"marks":1978},"https://bcmj.org/articles/quality-improvement-project-enhance-management-hyperkalemia-hospitalized-patients",[1979],{"type":398,"attrs":1980},{"href":1977,"uuid":53,"anchor":53,"custom":1981,"target":597,"linktype":598},{},{"type":15,"attrs":1983},{"textAlign":53},{"type":441,"content":1985},[1986],{"type":15,"attrs":1987,"content":1988},{"textAlign":53},[1989,1991],{"text":1990,"type":351},"Saskatchewan Health Authority – Saskatoon Area. Near Fatal: A Patient Safety Story. 2015. ",{"text":1392,"type":351,"marks":1992},[1993],{"type":398,"attrs":1994},{"href":1392,"uuid":53,"anchor":53,"custom":1995,"target":597,"linktype":598},{},{"type":12,"content":1997},[1998],{"type":15},{"id":16,"_uid":2000,"items":2001,"component":1097},"e3f3e7f5-4861-44b6-83e7-e50789a22016",[2002],{"_uid":2003,"link":2004,"image":2009,"title":1088,"component":1089,"description":2011},"5f1f912d-7262-45e5-bfa7-681df565be83",[2005],{"_uid":2006,"link":2007,"label":1082,"component":1083},"686fcf6b-4a18-4327-8c09-6da675dedf0f",{"id":1077,"url":16,"linktype":404,"fieldtype":599,"cached_url":1078,"story":2008},{"name":1080,"id":1081,"uuid":1077,"slug":9,"url":1078,"full_slug":1078,"_stopResolving":291},{"id":1085,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1086,"copyright":16,"fieldtype":283,"meta_data":2010,"is_external_url":285},{},{"type":12,"content":2012},[2013],{"type":15,"attrs":2014,"content":2015},{"textAlign":53},[2016],{"text":1096,"type":351},[129,150,136,122,143,115,157],[185,192,200],"electrolyte-and-fluid-imbalance","resources/electrolyte-and-fluid-imbalance",-18620,[],"cc88ab63-3392-467f-bb95-2298a7edf622","2025-12-10T19:19:52.192Z",[],[2027],{"path":2028,"name":53,"lang":305,"published":53},"ressources/electrolyte-and-fluid-imbalance",{"name":2030,"created_at":2031,"published_at":2032,"updated_at":2033,"id":2034,"uuid":2035,"content":2036,"slug":3464,"full_slug":3465,"sort_by_date":53,"position":3466,"tag_list":3467,"is_startpage":285,"parent_id":1105,"meta_data":53,"group_id":3468,"first_published_at":3469,"release_id":53,"lang":299,"path":53,"alternates":3470,"default_full_slug":3465,"translated_slugs":3471},"Sepsis","2025-12-08T22:21:25.214Z","2026-03-10T16:39:41.351Z","2026-03-10T16:39:41.426Z",121007657911080,"56837567-1639-458f-9e77-5f782ddae91f",{"new":285,"seo":2037,"_uid":331,"hero":2039,"type":174,"topics":2060,"Noindex":285,"content":2061,"audience":3462,"duration":16,"regional":3463,"component":1100},{"_uid":328,"title":2030,"plugin":329,"og_image":16,"og_title":16,"description":2038,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},"Healthcare Excellence Canada has developed this Hospital Harm Improvement Resource – a compilation of resources to support patient safety and improvement efforts.",[2040],{"_uid":334,"image":2041,"title":2043,"format":2044,"component":343,"description":2047,"key_learning":2054,"prerequisite":2057},{"id":336,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":337,"copyright":16,"fieldtype":283,"meta_data":2042,"is_external_url":285},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Sepsis",{"type":12,"content":2045},[2046],{"type":15},{"type":12,"content":2048},[2049],{"type":15,"attrs":2050,"content":2051},{"textAlign":53},[2052],{"text":2053,"type":351},"Sepsis is defined as: \"life-threatening organ dysfunction caused by dysregulated host response to infection\" (Singer et al., 2016). It affects neonatal, pediatric, and adult patients worldwide. Differentiated from an uncomplicated infection by virtue of the dysregulated host response and acute organ dysfunction, sepsis can present as or progress to septic shock, recently redefined as: \"a subset of sepsis in which particularly profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone.\" (Singer et al., 2016). Maternal sepsis is a life-threatening condition defined as an organ dysfunction caused by an infection during pregnancy, delivery, puerperium, or after an abortion (Escobar et al., 2020).",{"type":12,"content":2055},[2056],{"type":15},{"type":12,"content":2058},[2059],{"type":15},[76,8],[2062,2073,2242,2604,2636,3235,3299,3444],{"_uid":361,"link":2063,"image":2064,"title":365,"component":366,"media_type":367,"description":2066},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":283,"meta_data":2065},{},{"type":12,"content":2067},[2068],{"type":15,"attrs":2069,"content":2070},{"textAlign":53},[2071],{"text":2072,"type":351},"To decrease the morbidity and mortality from sepsis and to prevent nosocomial sepsis in the hospitalized pediatric and adult population.",{"_uid":376,"content":2074,"component":585},[2075],{"_uid":379,"content":2076,"component":584},{"type":12,"content":2077},[2078,2082,2093,2098,2103,2108,2113,2118,2123,2202,2206,2210,2216,2228,2233],{"type":383,"attrs":2079,"content":2080},{"level":385,"textAlign":53},[2081],{"text":388,"type":351},{"type":15,"attrs":2083,"content":2084},{"textAlign":53},[2085,2086,2092],{"text":393,"type":351},{"text":395,"type":351,"marks":2087},[2088],{"type":398,"attrs":2089},{"href":400,"uuid":401,"anchor":53,"custom":2090,"target":403,"linktype":404,"story":2091},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":410,"type":351},{"type":15,"attrs":2094,"content":2095},{"textAlign":53},[2096],{"text":2097,"type":351},"Healthcare-associated infections (HAIs) can lead to sepsis and its deleterious outcomes (Riley & Wheeler, 2012). Failure to comply with evidence-based infection preventive practices for HAIs increases the incidence of hospital-acquired sepsis.",{"type":15,"attrs":2099,"content":2100},{"textAlign":53},[2101],{"text":2102,"type":351},"HAIs account for a large proportion of patient safety incidents in Canada. Every year, it is estimated that 220,000 Canadian patients (approximately one in nine) will develop an infection during their stay in hospital. Complicating the problem is the fact that many HAIs are caused by antimicrobial-resistant organisms (AROs), which make them difficult to treat. Although progress has been made to prevent and control ARO-related HAIs, much work remains to be done. Globally and in Canada, the steps taken to mitigate antimicrobial resistance (AMR) are relatively limited (MacLaurin et al., 2020). The Public Health Agency of Canada (PHAC) estimates that approximately two per cent of patients admitted to large, academic Canadian hospitals will have acquired an infection with an ARO during the course of their hospital stay (Mitchell et al., 2019) and that at any given time, three to 10 per cent of patients who are hospitalized in Canada will either be infected or be a carrier of an ARO (Martin et al., 2019).",{"type":15,"attrs":2104,"content":2105},{"textAlign":53},[2106],{"text":2107,"type":351},"Canada continues to lag behind other OECD countries on sepsis following abdominal surgery (CIHI, 2019b). In 2019, the Canadian in-hospital sepsis rate was 3.9 per 1,000 patients (CIHI, 2019a).  Sepsis affects approximately 1.7 million adults in the United States each year and potentially contributes to more than 250,000 deaths. Various studies estimate that sepsis is present in 30 to 50 per cent of hospitalizations that culminate in death. The high burden of sepsis and the perception that most sepsis-associated deaths are preventable with better care has catalyzed numerous sepsis performance improvement initiatives in hospitals around the world (Rhee et al., 2019).  ",{"type":15,"attrs":2109,"content":2110},{"textAlign":53},[2111],{"text":2112,"type":351},"It has been reported in a recent study that hospital-onset sepsis preferentially afflicted ill patients but even after risk-adjustment, they were twice as likely to die as community-onset sepsis patients; in patients admitted without sepsis, hospital-onset sepsis tripled the risk of death. Hospital-onset sepsis is an important target for surveillance, prevention, and quality improvement initiatives (Rhee et al., 2019).",{"type":15,"attrs":2114,"content":2115},{"textAlign":53},[2116],{"text":2117,"type":351},"Recommendations for guiding care for adults with critical or severe Coronavirus associated sepsis have been developed by the Surviving Sepsis Campaign Coronavirus Disease 2019 panel and will be updated as necessary (Alhazzani et al., 2020). ",{"type":383,"attrs":2119,"content":2120},{"level":413,"textAlign":53},[2121],{"text":2122,"type":351},"Risk Factors",{"type":438,"content":2124},[2125,2132,2139,2146,2153,2160,2167,2174,2181,2188,2195],{"type":441,"content":2126},[2127],{"type":15,"attrs":2128,"content":2129},{"textAlign":53},[2130],{"text":2131,"type":351},"Examples of risk factors are:",{"type":441,"content":2133},[2134],{"type":15,"attrs":2135,"content":2136},{"textAlign":53},[2137],{"text":2138,"type":351},"Age (higher risk in neonates and elderly persons than in other age groups).",{"type":441,"content":2140},[2141],{"type":15,"attrs":2142,"content":2143},{"textAlign":53},[2144],{"text":2145,"type":351},"Chronic diseases with/without severe organ dysfunction.",{"type":441,"content":2147},[2148],{"type":15,"attrs":2149,"content":2150},{"textAlign":53},[2151],{"text":2152,"type":351},"Immunodeficiency.",{"type":441,"content":2154},[2155],{"type":15,"attrs":2156,"content":2157},{"textAlign":53},[2158],{"text":2159,"type":351},"Immunosuppressive agents.",{"type":441,"content":2161},[2162],{"type":15,"attrs":2163,"content":2164},{"textAlign":53},[2165],{"text":2166,"type":351},"Inappropriate use of antibiotics.",{"type":441,"content":2168},[2169],{"type":15,"attrs":2170,"content":2171},{"textAlign":53},[2172],{"text":2173,"type":351},"The presence of implanted medical devices (intravascular or other).",{"type":441,"content":2175},[2176],{"type":15,"attrs":2177,"content":2178},{"textAlign":53},[2179],{"text":2180,"type":351},"Pregnancy.",{"type":441,"content":2182},[2183],{"type":15,"attrs":2184,"content":2185},{"textAlign":53},[2186],{"text":2187,"type":351},"Prematurity.",{"type":441,"content":2189},[2190],{"type":15,"attrs":2191,"content":2192},{"textAlign":53},[2193],{"text":2194,"type":351},"Infection is more likely to occur when the normal anatomy is altered by a process – benign or malignant - that either obstructs a normal passage (e.g., calculous cholecystitis, prostatitis) or breaks and enters a previously sterile system (e.g., skin breakdown by trauma, dermatological conditions).",{"type":441,"content":2196},[2197],{"type":15,"attrs":2198,"content":2199},{"textAlign":53},[2200],{"text":2201,"type":351},"Patients unable to communicate their symptoms often present later in their illness (i.e., often with sepsis) (CPSI et al., 2015).",{"type":383,"attrs":2203,"content":2204},{"level":385,"textAlign":53},[2205],{"text":640,"type":351},{"type":383,"attrs":2207,"content":2208},{"level":413,"textAlign":53},[2209],{"text":1383,"type":351},{"type":383,"attrs":2211,"content":2213},{"level":2212,"textAlign":53},4,[2214],{"text":2215,"type":351},"Julie's Story",{"type":15,"attrs":2217,"content":2218},{"textAlign":53},[2219,2221,2226],{"text":2220,"type":351},"This short documentary accompanies \"",{"text":2215,"type":351,"marks":2222},[2223],{"type":398,"attrs":2224},{"href":2225,"uuid":53,"anchor":53,"custom":1825,"target":597,"linktype":598},"https://www.patientstories.org.uk/recent-posts/julies-story-now-available/",{"text":2227,"type":351},"\". In 2008, Julie Carman was involved in a road traffic accident whilst on a cycling holiday. She suffered injuries to her face, jaw and legs but made a good initial recovery and expected to be back at work within three months. Three years later she was still having treatment having experienced two further emergency admissions to hospital due to acute cellulitis and sepsis. In this short film, Julie explains how a series of \"everyday\" communication failures conspired to create delays in her receiving effective treatment (Patient Stories, 2013).",{"type":383,"attrs":2229,"content":2230},{"level":2212,"textAlign":53},[2231],{"text":2232,"type":351},"Additional Sepsis Survival Stories",{"type":15,"attrs":2234,"content":2235},{"textAlign":53},[2236],{"text":2237,"type":351,"marks":2238},"https://bcpsqc.ca/improve-care/sepsis/sepsis-survival-stories/",[2239],{"type":398,"attrs":2240},{"href":2241,"uuid":53,"anchor":53,"custom":1825,"target":597,"linktype":598},"https://healthqualitybc.ca/improve-care/sepsis/sepsis-survival-stories/",{"_uid":650,"items":2243,"title":765,"component":641,"description":2561},[2244],{"_uid":653,"title":654,"ctaLeft":2245,"ctaRight":2246,"component":603,"columnLeft":2247,"columnRight":2272},[],[],{"type":12,"content":2248},[2249],{"type":15,"attrs":2250,"content":2251},{"textAlign":53},[2252,2259,2268],{"text":2253,"type":351,"marks":2254},"To develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for conducting chart audits and analysis methods are included in the ",[2255],{"type":2256,"attrs":2257},"textStyle",{"color":2258},"#000000",{"text":2260,"type":351,"marks":2261},"Hospital Harm Improvement Resource Introduction",[2262,2266],{"type":398,"attrs":2263},{"href":400,"uuid":401,"anchor":53,"custom":2264,"target":403,"linktype":404,"story":2265},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"type":2267},"underline",{"text":672,"type":351,"marks":2269},[2270],{"type":2256,"attrs":2271},{"color":2258},{"type":12,"content":2273},[2274,2285,2290,2513,2520],{"type":15,"attrs":2275,"content":2276},{"textAlign":53},[2277,2278,2284],{"text":663,"type":351},{"text":665,"type":351,"marks":2279},[2280],{"type":398,"attrs":2281},{"href":400,"uuid":401,"anchor":53,"custom":2282,"target":403,"linktype":404,"story":2283},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":1450,"type":351},{"type":15,"attrs":2286,"content":2287},{"textAlign":53},[2288],{"text":2289,"type":351},"If your review reveals that your cases of Sepsis are linked to specific processes or procedures, you may find these resources helpful:",{"type":438,"content":2291},[2292,2305,2318,2331,2338,2345,2352,2370,2383,2396,2409,2422,2435,2448,2461,2474,2487,2500],{"type":441,"content":2293},[2294],{"type":15,"attrs":2295,"content":2296},{"textAlign":53},[2297,2299],{"text":2298,"type":351},"BC Patient Safety and Quality Council ",{"text":2300,"type":351,"marks":2301},"https://bcpsqc.ca/",[2302],{"type":398,"attrs":2303},{"href":2300,"uuid":53,"anchor":53,"custom":2304,"target":597,"linktype":598},{},{"type":441,"content":2306},[2307],{"type":15,"attrs":2308,"content":2309},{"textAlign":53},[2310,2312],{"text":2311,"type":351},"BC Patient Safety & Quality Council. BC Sepsis Network. BC Patient Safety & Quality Council. 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Sepsis: Clinical Information. Clinical Resources. Published December 7, 2020. Accessed March 2021. ",{"text":2391,"type":351,"marks":2392},"https://www.cdc.gov/sepsis/clinicaltools/index.html",[2393],{"type":398,"attrs":2394},{"href":2391,"uuid":53,"anchor":53,"custom":2395,"target":597,"linktype":598},{},{"type":441,"content":2397},[2398],{"type":15,"attrs":2399,"content":2400},{"textAlign":53},[2401,2403],{"text":2402,"type":351},"Gould CV, Umscheid CA, Agarwal RK, Kuntz G, Pegues DA, Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for prevention of catheter-associated urinary tract infections 2009. Infection Control Hospital Epidemiology. 2010;31(4):319-326. ",{"text":2404,"type":351,"marks":2405},"http://www.cdc.gov/hicpac/pdf/cauti/cautiguideline2009final.pdf",[2406],{"type":398,"attrs":2407},{"href":2404,"uuid":53,"anchor":53,"custom":2408,"target":597,"linktype":598},{},{"type":441,"content":2410},[2411],{"type":15,"attrs":2412,"content":2413},{"textAlign":53},[2414,2416],{"text":2415,"type":351},"Novosad SA, Sapiano MRP, Grigg C, et al. Vital Signs: Epidemiology of Sepsis: Prevalence of Health Care Factors and Opportunities for Prevention. Morbidity and Mortality Weekly Report. 2016;65(33):864-869. ",{"text":2417,"type":351,"marks":2418},"http://dx.doi.org/10.15585/mmwr.mm6533e1",[2419],{"type":398,"attrs":2420},{"href":2417,"uuid":53,"anchor":53,"custom":2421,"target":597,"linktype":598},{},{"type":441,"content":2423},[2424],{"type":15,"attrs":2425,"content":2426},{"textAlign":53},[2427,2429],{"text":2428,"type":351},"Tumpey A. Empowering Nurses for Early Sepsis Recognition; 2016. Accessed March 2021. ",{"text":2430,"type":351,"marks":2431},"https://www.youtube.com/watch?v=s687VMj6iwo",[2432],{"type":398,"attrs":2433},{"href":2430,"uuid":53,"anchor":53,"custom":2434,"target":597,"linktype":598},{},{"type":441,"content":2436},[2437],{"type":15,"attrs":2438,"content":2439},{"textAlign":53},[2440,2442],{"text":2441,"type":351},"Tumpey A. Sepsis Standard Work: Improving Compliance with Early Recognition and Management of Perinatal Sepsis; 2017. ",{"text":2443,"type":351,"marks":2444},"https://www.youtube.com/watch?v=BUuFfwsj1W4",[2445],{"type":398,"attrs":2446},{"href":2443,"uuid":53,"anchor":53,"custom":2447,"target":597,"linktype":598},{},{"type":441,"content":2449},[2450],{"type":15,"attrs":2451,"content":2452},{"textAlign":53},[2453,2455],{"text":2454,"type":351},"Tumpey A. Advances in Sepsis: Protecting Patients Throughout the Lifespan; 2016. Accessed March 23, 2021. ",{"text":2456,"type":351,"marks":2457},"https://www.youtube.com/watch?v=EASYi4-_bv4",[2458],{"type":398,"attrs":2459},{"href":2456,"uuid":53,"anchor":53,"custom":2460,"target":597,"linktype":598},{},{"type":441,"content":2462},[2463],{"type":15,"attrs":2464,"content":2465},{"textAlign":53},[2466,2468],{"text":2467,"type":351},"Global Sepsis Alliance ",{"text":2469,"type":351,"marks":2470},"www.global-sepsis-alliance.org",[2471],{"type":398,"attrs":2472},{"href":2469,"uuid":53,"anchor":53,"custom":2473,"target":597,"linktype":598},{},{"type":441,"content":2475},[2476],{"type":15,"attrs":2477,"content":2478},{"textAlign":53},[2479,2481],{"text":2480,"type":351},"Infection Prevention and Control Canada 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with age on admission less than 1 year.",{"type":441,"content":2661},[2662],{"type":15,"attrs":2663,"content":2664},{"textAlign":53},[2665],{"text":2666,"type":351},"Abstracts with a length of stay less than 2 days",{"type":441,"content":2668},[2669],{"type":15,"attrs":2670,"content":2671},{"textAlign":53},[2672],{"text":2673,"type":351},"Abstracts with a most responsible diagnosis of palliative care (ICD-10-CA: Z51:5)",{"type":441,"content":2675},[2676],{"type":15,"attrs":2677,"content":2678},{"textAlign":53},[2679],{"text":2680,"type":351},"Abstracts where sepsis is also identified as a pre-admit condition are excluded from the numerator:",{"type":438,"content":2682},[2683,2690],{"type":441,"content":2684},[2685],{"type":15,"attrs":2686,"content":2687},{"textAlign":53},[2688],{"text":2689,"type":351},"Abstracts with sepsis codes (ICD-10-CA: A40.–, A41.–, B37.7, R65.1, R57.2) or the associated post-procedural complication codes (ICD-10-CA: T80.2, T81.1, T81.4, T82.6, T82.7–, T83.5, T83.6, T84.5–, T84.6–, T84.7, T85.7, T88.0) identified as pre-admit [type (M), (1), (W), (X) or (Y)]",{"type":441,"content":2691},[2692],{"type":15,"attrs":2693,"content":2694},{"textAlign":53},[2695],{"text":2696,"type":351},"Abstract with sepsis in obstetric patients where the puerperal sepsis code or the associated obstetric infection code is identified as pre-admit [ICD-10-CA: O85.004, O85.009, O98.501, O98.503, O98.504, O98.509, O98.801, O98.803, O98.804, O98.809 — any diagnosis type or O03.0, O03.5, O04.0, O04.5, O05.0, O05.5, O07.3, O08.0 as type (M), (1), (W), (X) or (Y)]",{"type":15,"attrs":2698,"content":2699},{"textAlign":53},[2700],{"text":2701,"type":351},"As an exception, sepsis is not considered as a pre-admit condition when the above codes identified as type (M), (W), (X) or (Y) also appear as type (2) or within a post-admit sepsis coding scenario (sepsis code as type (2); sepsis code as type (3) or an associated infection code as type (2) in sepsis as post-procedural or obstetric complications",{"type":12,"content":2703},[2704,2713,2727,2735,2743,2750,2758,2765,2773,2782],{"type":15,"attrs":2705,"content":2706},{"textAlign":53},[2707,2711],{"text":2708,"type":351,"marks":2709},"Code",[2710],{"type":677},{"text":2712,"type":351},": Condition",{"type":15,"attrs":2714,"content":2715},{"textAlign":53},[2716,2723],{"text":2717,"type":351,"marks":2718},"A40.–, A41.–, B37.7, R57.2, R65.1",[2719,2722],{"type":2256,"attrs":2720},{"color":2721},"#575757",{"type":677},{"text":1677,"type":351,"marks":2724},[2725],{"type":2256,"attrs":2726},{"color":2721},{"type":15,"attrs":2728,"content":2729},{"textAlign":53},[2730],{"text":2731,"type":351,"marks":2732},"OR",[2733],{"type":2256,"attrs":2734},{"color":2721},{"type":15,"attrs":2736,"content":2737},{"textAlign":53},[2738],{"text":2739,"type":351,"marks":2740},"Identified as diagnosis type (3) AND T80.2, T81.4, T82.6,   T82.7–, T83.5, T83.6, T84.5–, T84.6–, T84.7, T85.7 or T88.0 as diagnosis type (2) AND Y60–Y84 in the same diagnosis cluster",[2741],{"type":2256,"attrs":2742},{"color":2721},{"type":15,"attrs":2744,"content":2745},{"textAlign":53},[2746],{"text":2731,"type":351,"marks":2747},[2748],{"type":2256,"attrs":2749},{"color":2721},{"type":15,"attrs":2751,"content":2752},{"textAlign":53},[2753],{"text":2754,"type":351,"marks":2755},"Identified as diagnosis type (3) AND O03.0, O03.5, O04.0, O04.5, O05.0, O05.5, O07.3 or O08.0– as diagnosis type (2) on the same abstract",[2756],{"type":2256,"attrs":2757},{"color":2721},{"type":15,"attrs":2759,"content":2760},{"textAlign":53},[2761],{"text":2731,"type":351,"marks":2762},[2763],{"type":2256,"attrs":2764},{"color":2721},{"type":15,"attrs":2766,"content":2767},{"textAlign":53},[2768],{"text":2769,"type":351,"marks":2770},"Identified as diagnosis type (3) AND O98.502 or O98.802 as diagnosis type (M), (1), (2), (W), (X) or (Y) on the same 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cluster",{"_uid":1697,"title":1698,"ctaLeft":2792,"ctaRight":2793,"component":603,"columnLeft":2794,"columnRight":2798},[],[],{"type":12,"content":2795},[2796],{"type":15,"attrs":2797},{"textAlign":53},{"type":12,"content":2799},[2800,2808,2817,2826,2835,2844,2853,2862,2871,2880,2889,2898,2907,2915,2924,2933,2941],{"type":15,"attrs":2801,"content":2802},{"textAlign":53},[2803,2806],{"text":2708,"type":351,"marks":2804},[2805],{"type":677},{"text":2807,"type":351},": Code Description",{"type":15,"attrs":2809,"content":2810},{"textAlign":53},[2811,2815],{"text":2812,"type":351,"marks":2813},"A40",[2814],{"type":677},{"text":2816,"type":351},": Streptococcal sepsis",{"type":15,"attrs":2818,"content":2819},{"textAlign":53},[2820,2824],{"text":2821,"type":351,"marks":2822},"A41",[2823],{"type":677},{"text":2825,"type":351},".–: Other 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JAMA. 2016;315(8):801-810. doi:10.1001/jama.2016.0287",{"type":12,"content":3442},[3443],{"type":15},{"id":16,"_uid":3445,"items":3446,"component":1097},"3232811b-05e5-479b-9e6c-665a88720966",[3447],{"_uid":3448,"link":3449,"image":3454,"title":1088,"component":1089,"description":3456},"23611e6c-ad93-4f48-a4de-8720b1179679",[3450],{"_uid":3451,"link":3452,"label":1082,"component":1083},"a8a2c546-f504-48a1-94c9-0a04e7154602",{"id":1077,"url":16,"linktype":404,"fieldtype":599,"cached_url":1078,"story":3453},{"name":1080,"id":1081,"uuid":1077,"slug":9,"url":1078,"full_slug":1078,"_stopResolving":291},{"id":1085,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1086,"copyright":16,"fieldtype":283,"meta_data":3455,"is_external_url":285},{},{"type":12,"content":3457},[3458],{"type":15,"attrs":3459,"content":3460},{"textAlign":53},[3461],{"text":1096,"type":351},[129,150,136,122,143,115,157],[185,192,200],"sepsis","resources/sepsis",-18630,[],"b1b1354c-2415-4bdc-8e10-792767f9a80b","2025-12-08T23:10:07.863Z",[],[3472],{"path":3473,"name":3464,"lang":305,"published":291},"ressources/la-septicemie",{"name":3475,"created_at":3476,"published_at":3477,"updated_at":3478,"id":3479,"uuid":3480,"content":3481,"slug":4346,"full_slug":4347,"sort_by_date":53,"position":4348,"tag_list":4349,"is_startpage":285,"parent_id":1105,"meta_data":53,"group_id":4350,"first_published_at":4351,"release_id":53,"lang":299,"path":53,"alternates":4352,"default_full_slug":4347,"translated_slugs":4353},"Hypoglycemia","2025-12-09T18:22:55.239Z","2026-03-16T18:13:44.914Z","2026-03-16T18:13:44.986Z",121302938653493,"83a2d26c-04ec-4b52-8485-8ba467f79a24",{"new":285,"seo":3482,"_uid":331,"hero":3483,"type":174,"topics":3504,"Noindex":285,"content":3505,"audience":4344,"duration":16,"regional":4345,"component":1100},{"_uid":328,"title":3475,"plugin":329,"og_image":16,"og_title":16,"description":2038,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[3484],{"_uid":334,"image":3485,"title":3487,"format":3488,"component":343,"description":3491,"key_learning":3498,"prerequisite":3501},{"id":336,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":337,"copyright":16,"fieldtype":283,"meta_data":3486,"is_external_url":285},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Hypoglycemia",{"type":12,"content":3489},[3490],{"type":15},{"type":12,"content":3492},[3493],{"type":15,"attrs":3494,"content":3495},{"textAlign":53},[3496],{"text":3497,"type":351},"Hypoglycemia is defined as any blood glucose less than 4.0 mmol/L. When blood glucose decreases to 2.8 mmol/L, cognitive impairment ensues (Canadian Diabetes Association (CDA), Clayton, Woo, Yale 2013). Hypoglycemia is a widely recognized cause of acute, potentially fatal events.",{"type":12,"content":3499},[3500],{"type":15},{"type":12,"content":3502},[3503],{"type":15},[76],[3506,3517,3711,3725,3853,3885,4107,4205,4326],{"_uid":361,"link":3507,"image":3508,"title":365,"component":366,"media_type":367,"description":3510},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":283,"meta_data":3509},{},{"type":12,"content":3511},[3512],{"type":15,"attrs":3513,"content":3514},{"textAlign":53},[3515],{"text":3516,"type":351},"Reduce the incidence of hypoglycemia in diabetic and non-diabetic patients during a hospital stay.",{"_uid":376,"content":3518,"component":585},[3519],{"_uid":379,"content":3520,"component":584},{"type":12,"content":3521},[3522,3526,3537,3542,3547,3552,3559,3684,3689,3694,3701,3706],{"type":383,"attrs":3523,"content":3524},{"level":385,"textAlign":53},[3525],{"text":388,"type":351},{"type":15,"attrs":3527,"content":3528},{"textAlign":53},[3529,3530,3536],{"text":393,"type":351},{"text":395,"type":351,"marks":3531},[3532],{"type":398,"attrs":3533},{"href":400,"uuid":401,"anchor":53,"custom":3534,"target":403,"linktype":404,"story":3535},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":410,"type":351},{"type":15,"attrs":3538,"content":3539},{"textAlign":53},[3540],{"text":3541,"type":351},"Patients with or without diabetes may experience hypoglycemia in the hospital due to co-morbidities such as heart failure, renal or liver disease, malignancy, infection or sepsis or in association with an altered nutritional state. Additional triggering events include sudden reduction of corticosteroid dose, altered ability of the patient to report symptoms, reduced oral intake, emesis, new \"nothing by mouth\" (NPO) status, inappropriate timing of short- or rapid-acting insulin in relation to meals, and unexpected interruption of enteral feedings or parenteral nutrition (American Diabetes Association (ADA) 2015; CDA, Houlden, Capes, Clement, Miller 2013; Rubin & Golden 2013).",{"type":15,"attrs":3543,"content":3544},{"textAlign":53},[3545],{"text":3546,"type":351},"Patients with diabetes are at a higher risk of hypoglycemia than other patients due to the added risk of medication errors involving insulin (Rubin & Golden 2013). Hypoglycemia is associated with increased length of stay and inpatient mortality (Nirantharakumar et al. 2012). In patients with type 2 diabetes and established cardiovascular disease (or very high risk for cardiovascular disease), symptomatic hypoglycemia (\u003C2.8 mmol/L) is associated with increased mortality (CDA, Clayton, Woo, Yale 2013).",{"type":15,"attrs":3548,"content":3549},{"textAlign":53},[3550],{"text":3551,"type":351},"Symptoms of hypoglycemia are sweating, shakiness, tachycardia, anxiety, hunger, weakness, fatigue, dizziness, difficulty concentrating, confusion and blurred vision. In extreme cases, hypoglycemia may lead to coma and death (Desimone & Weinstock 2016). The Canadian Diabetes Association (CDA, Clayton, Woo, Yale 2013) lists the symptoms of hypoglycemia according to neurogenic (autonomic) and neuroglycopenic symptoms (see Table 1 below).",{"type":383,"attrs":3553,"content":3554},{"level":2212,"textAlign":775},[3555],{"text":3556,"type":351,"marks":3557},"Symptoms of hypoglycemia",[3558],{"type":677},{"type":438,"content":3560},[3561,3619],{"type":441,"content":3562},[3563,3568],{"type":15,"attrs":3564,"content":3565},{"textAlign":775},[3566],{"text":3567,"type":351},"Neurogenic (autonomic)",{"type":438,"content":3569},[3570,3577,3584,3591,3598,3605,3612],{"type":441,"content":3571},[3572],{"type":15,"attrs":3573,"content":3574},{"textAlign":775},[3575],{"text":3576,"type":351},"Trembling",{"type":441,"content":3578},[3579],{"type":15,"attrs":3580,"content":3581},{"textAlign":775},[3582],{"text":3583,"type":351},"Palpitations",{"type":441,"content":3585},[3586],{"type":15,"attrs":3587,"content":3588},{"textAlign":775},[3589],{"text":3590,"type":351},"Sweating",{"type":441,"content":3592},[3593],{"type":15,"attrs":3594,"content":3595},{"textAlign":775},[3596],{"text":3597,"type":351},"Anxiety",{"type":441,"content":3599},[3600],{"type":15,"attrs":3601,"content":3602},{"textAlign":775},[3603],{"text":3604,"type":351},"Hunger",{"type":441,"content":3606},[3607],{"type":15,"attrs":3608,"content":3609},{"textAlign":775},[3610],{"text":3611,"type":351},"Nausea",{"type":441,"content":3613},[3614],{"type":15,"attrs":3615,"content":3616},{"textAlign":775},[3617],{"text":3618,"type":351},"Tingling",{"type":441,"content":3620},[3621,3626],{"type":15,"attrs":3622,"content":3623},{"textAlign":775},[3624],{"text":3625,"type":351},"Neuroglycopenic",{"type":438,"content":3627},[3628,3635,3642,3649,3656,3663,3670,3677],{"type":441,"content":3629},[3630],{"type":15,"attrs":3631,"content":3632},{"textAlign":775},[3633],{"text":3634,"type":351},"Difficulty concentrating",{"type":441,"content":3636},[3637],{"type":15,"attrs":3638,"content":3639},{"textAlign":775},[3640],{"text":3641,"type":351},"Confusion",{"type":441,"content":3643},[3644],{"type":15,"attrs":3645,"content":3646},{"textAlign":775},[3647],{"text":3648,"type":351},"Weakness",{"type":441,"content":3650},[3651],{"type":15,"attrs":3652,"content":3653},{"textAlign":775},[3654],{"text":3655,"type":351},"Drowsiness",{"type":441,"content":3657},[3658],{"type":15,"attrs":3659,"content":3660},{"textAlign":775},[3661],{"text":3662,"type":351},"Vision changes",{"type":441,"content":3664},[3665],{"type":15,"attrs":3666,"content":3667},{"textAlign":53},[3668],{"text":3669,"type":351},"Difficulty speaking",{"type":441,"content":3671},[3672],{"type":15,"attrs":3673,"content":3674},{"textAlign":53},[3675],{"text":3676,"type":351},"Headache",{"type":441,"content":3678},[3679],{"type":15,"attrs":3680,"content":3681},{"textAlign":53},[3682],{"text":3683,"type":351},"Dizziness",{"type":383,"attrs":3685,"content":3686},{"level":413,"textAlign":53},[3687],{"text":3688,"type":351},"Hypoglycemia with diabetes mellitus, type 1 or type 2",{"type":15,"attrs":3690,"content":3691},{"textAlign":53},[3692],{"text":3693,"type":351},"Insulin is the most appropriate agent for effectively controlling glycemia in-hospital (CDA, Houlden, Capes, Clement, Miller 2013). However, insulin causes the most harm and severe adverse events of the high alert medications (CDA, Houlden, Capes, Clement, Miller 2013; ISMP 2016). Mild hypoglycemic events are common in medical and surgical patients with type 2 diabetes who are receiving subcutaneous insulin therapy. Increasing age, impaired renal function, daily insulin dose, and insulin regimen (basal/bolus versus SSI) are important predictors of hypoglycemia in patients with type 2 diabetes mellitus who are on insulin therapy (Farrokhi et al. 2012).",{"type":383,"attrs":3695,"content":3696},{"level":413,"textAlign":775},[3697],{"text":3698,"type":351,"marks":3699},"Nondiabetic hypoglycemic coma and drug-induced hypoglycemia without coma",[3700],{"type":677},{"type":15,"attrs":3702,"content":3703},{"textAlign":775},[3704],{"text":3705,"type":351},"Hypoglycemia is uncommon in patients who do not have diabetes. Drugs are the most common cause of nondiabetic hypoglycemia. Other causes are malnutrition and alcohol use. Hypoglycemia may also follow bariatric surgery.",{"type":15,"attrs":3707,"content":3708},{"textAlign":775},[3709],{"text":3710,"type":351},"Drugs that may lead to hypoglycemia include: Bactrim (sulfamethoxazole and trimethoprim), beta-blockers, haloperidol, MAO (monoamine oxidase) inhibitors, pentamidine, quinidine, quinine, ACE (angiotensin-converting enzyme) inhibitors, lithium and second generation antipsychotic agents as well as medications used in the treatment of diabetes, such as insulin or oral medications used for management of type 2 diabetes (Cryer 2011; Desimone & Weinstock 2016; Murad et al., 2009; Suzuki et al. 2009). Hypoglycemia secondary to these drugs is higher in elderly patients and in patients with sepsis, and renal or hepatic disease (Murad et al. 2009).",{"_uid":1359,"content":3712,"component":585},[3713],{"_uid":1362,"content":3714,"component":584},{"type":12,"content":3715},[3716,3720],{"type":383,"attrs":3717,"content":3718},{"level":385,"textAlign":53},[3719],{"text":640,"type":351},{"type":15,"attrs":3721,"content":3722},{"textAlign":53},[3723],{"text":3724,"type":351},"Hypoglycemia causes tremor, anxiety, sweats and cognitive impairment. Recurrent hypoglycemia may impair the individual's ability to sense subsequent hypoglycemia (CDA, Clayton, Woo, Yale, 2013). In severe cases it may be fatal, although inpatient hypoglycemia is usually nonfatal (Rubin & Golden, 2013). Patients and families can play an important role in reducing errors and harm to the patient by understanding the medications the patient is taking, what each medication is for and when it should be taken and the dosage.",{"_uid":650,"items":3726,"title":765,"component":641,"description":3813},[3727],{"_uid":653,"title":654,"ctaLeft":3728,"ctaRight":3729,"component":603,"columnLeft":3730,"columnRight":3734},[],[],{"type":12,"content":3731},[3732],{"type":15,"attrs":3733},{"textAlign":53},{"type":12,"content":3735},[3736,3747,3752],{"type":15,"attrs":3737,"content":3738},{"textAlign":53},[3739,3740,3746],{"text":663,"type":351},{"text":665,"type":351,"marks":3741},[3742],{"type":398,"attrs":3743},{"href":400,"uuid":401,"anchor":53,"custom":3744,"target":403,"linktype":404,"story":3745},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":1450,"type":351},{"type":15,"attrs":3748,"content":3749},{"textAlign":53},[3750],{"text":3751,"type":351},"If your review reveals that your cases of hypoglycemia in diabetic and non-diabetic patients identified during a hospital stay are linked to specific practice or process issues, you may find these resources helpful:",{"type":438,"content":3753},[3754,3767,3780,3793,3806],{"type":441,"content":3755},[3756],{"type":15,"attrs":3757,"content":3758},{"textAlign":53},[3759,3761],{"text":3760,"type":351},"American Diabetes Association ",{"text":3762,"type":351,"marks":3763},"www.diabetes.org",[3764],{"type":398,"attrs":3765},{"href":3766,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},"http://www.diabetes.org",{"type":441,"content":3768},[3769],{"type":15,"attrs":3770,"content":3771},{"textAlign":53},[3772,3774],{"text":3773,"type":351},"Canadian Diabetes Association ",{"text":3775,"type":351,"marks":3776},"www.diabetes.ca",[3777],{"type":398,"attrs":3778},{"href":3779,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},"http://www.diabetes.ca",{"type":441,"content":3781},[3782],{"type":15,"attrs":3783,"content":3784},{"textAlign":53},[3785,3787],{"text":3786,"type":351},"Institute for Safe Medication Practices ",{"text":3788,"type":351,"marks":3789},"www.ismp.org",[3790],{"type":398,"attrs":3791},{"href":3792,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},"http://www.ismp.org",{"type":441,"content":3794},[3795],{"type":15,"attrs":3796,"content":3797},{"textAlign":53},[3798,3800],{"text":3799,"type":351},"Institute for Healthcare Improvement (IHI) ",{"text":3801,"type":351,"marks":3802},"www.ihi.org",[3803],{"type":398,"attrs":3804},{"href":3805,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},"http://www.ihi.org",{"type":441,"content":3807},[3808],{"type":15,"attrs":3809,"content":3810},{"textAlign":53},[3811],{"text":3812,"type":351},"Public Health Agency of Canada: Your Guide to Diabetes",{"type":12,"content":3814},[3815,3820,3824,3851],{"type":15,"attrs":3816,"content":3817},{"textAlign":53},[3818],{"text":3819,"type":351},"Given the broad range of potential causes of hypoglycemia, in addition to recommendations listed above, we recommend conducting clinical and system reviews to identify latent causes and determine appropriate recommendations.",{"type":15,"attrs":3821,"content":3822},{"textAlign":775},[3823],{"text":778,"type":351},{"type":780,"attrs":3825,"content":3826},{"order":782},[3827,3833,3839,3845],{"type":441,"content":3828},[3829],{"type":15,"attrs":3830,"content":3831},{"textAlign":53},[3832],{"text":790,"type":351},{"type":441,"content":3834},[3835],{"type":15,"attrs":3836,"content":3837},{"textAlign":53},[3838],{"text":797,"type":351},{"type":441,"content":3840},[3841],{"type":15,"attrs":3842,"content":3843},{"textAlign":53},[3844],{"text":804,"type":351},{"type":441,"content":3846},[3847],{"type":15,"attrs":3848,"content":3849},{"textAlign":53},[3850],{"text":811,"type":351},{"type":15,"attrs":3852},{"textAlign":775},{"_uid":813,"items":3854,"title":858,"component":859,"description":3879},[3855,3861,3867,3873],{"_uid":835,"image":3856,"title":1629,"component":822,"description":3858},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":3857,"is_external_url":285},{},{"type":12,"content":3859},[3860],{"type":15},{"_uid":827,"image":3862,"title":830,"component":822,"description":3864},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":3863,"is_external_url":285},{},{"type":12,"content":3865},[3866],{"type":15},{"_uid":816,"image":3868,"title":821,"component":822,"description":3870},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":3869,"is_external_url":285},{},{"type":12,"content":3871},[3872],{"type":15},{"_uid":843,"image":3874,"title":838,"component":822,"description":3876},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":3875,"is_external_url":285},{},{"type":12,"content":3877},[3878],{"type":15},{"type":12,"content":3880},[3881],{"type":15,"attrs":3882,"content":3883},{"textAlign":53},[3884],{"text":1657,"type":351},{"_uid":868,"items":3886,"title":890,"component":641,"description":4087},[3887,3978,4056],{"_uid":871,"title":872,"ctaLeft":3888,"ctaRight":3889,"component":603,"columnLeft":3890,"columnRight":3894},[],[],{"type":12,"content":3891},[3892],{"type":15,"attrs":3893},{"textAlign":53},{"type":12,"content":3895},[3896,3904],{"type":15,"attrs":3897,"content":3898},{"textAlign":53},[3899,3902],{"text":2708,"type":351,"marks":3900},[3901],{"type":677},{"text":3903,"type":351},": 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Identified as diagnosis type (2) ",{"text":3968,"type":351,"marks":3969},"AND ",[3970],{"type":677},{"text":3972,"type":351},"Y40–Y59 ",{"text":3974,"type":351,"marks":3975},"in the same diagnosis cluster",[3976],{"type":677},{"text":672,"type":351},{"_uid":1697,"title":1698,"ctaLeft":3979,"ctaRight":3980,"component":603,"columnLeft":3981,"columnRight":3985},[],[],{"type":12,"content":3982},[3983],{"type":15,"attrs":3984},{"textAlign":53},{"type":12,"content":3986},[3987,3994],{"type":15,"attrs":3988,"content":3989},{"textAlign":53},[3990,3993],{"text":2708,"type":351,"marks":3991},[3992],{"type":677},{"text":2807,"type":351},{"type":438,"content":3995},[3996,4006,4016,4026,4036,4046],{"type":441,"content":3997},[3998],{"type":15,"attrs":3999,"content":4000},{"textAlign":53},[4001,4004],{"text":3912,"type":351,"marks":4002},[4003],{"type":677},{"text":4005,"type":351},": Type 1 diabetes mellitus with hypoglycemia",{"type":441,"content":4007},[4008],{"type":15,"attrs":4009,"content":4010},{"textAlign":53},[4011,4014],{"text":3922,"type":351,"marks":4012},[4013],{"type":677},{"text":4015,"type":351},": Type 2 diabetes mellitus with hypoglycemia",{"type":441,"content":4017},[4018],{"type":15,"attrs":4019,"content":4020},{"textAlign":53},[4021,4024],{"text":3932,"type":351,"marks":4022},[4023],{"type":677},{"text":4025,"type":351},": Other specified diabetes mellitus with hypoglycemia",{"type":441,"content":4027},[4028],{"type":15,"attrs":4029,"content":4030},{"textAlign":53},[4031,4034],{"text":3942,"type":351,"marks":4032},[4033],{"type":677},{"text":4035,"type":351},": Unspecified diabetes mellitus with hypoglycemia",{"type":441,"content":4037},[4038],{"type":15,"attrs":4039,"content":4040},{"textAlign":53},[4041,4044],{"text":3952,"type":351,"marks":4042},[4043],{"type":677},{"text":4045,"type":351},": Nondiabetic hypoglycemic coma",{"type":441,"content":4047},[4048],{"type":15,"attrs":4049,"content":4050},{"textAlign":53},[4051,4054],{"text":3962,"type":351,"marks":4052},[4053],{"type":677},{"text":4055,"type":351},": Drug-induced hypoglycemia without coma",{"_uid":1743,"title":1744,"ctaLeft":4057,"ctaRight":4058,"component":603,"columnLeft":4059,"columnRight":4063},[],[],{"type":12,"content":4060},[4061],{"type":15,"attrs":4062},{"textAlign":53},{"type":12,"content":4064},[4065,4072],{"type":15,"attrs":4066,"content":4067},{"textAlign":53},[4068,4071],{"text":2708,"type":351,"marks":4069},[4070],{"type":677},{"text":2807,"type":351},{"type":15,"attrs":4073,"content":4074},{"textAlign":53},[4075,4079,4081,4086],{"text":4076,"type":351,"marks":4077},"Y40-Y59",[4078],{"type":677},{"text":4080,"type":351},": Drugs, medicaments and biological substances causing adverse effects in therapeutic use (refer to Appendix A of the ",{"text":1778,"type":351,"marks":4082},[4083],{"type":398,"attrs":4084},{"href":3345,"uuid":53,"anchor":53,"custom":4085,"target":597,"linktype":598},{},{"text":3095,"type":351},{"type":12,"content":4088},[4089,4093,4102],{"type":15,"attrs":4090,"content":4091},{"textAlign":53},[4092],{"text":1790,"type":351},{"type":438,"content":4094},[4095],{"type":441,"content":4096},[4097],{"type":15,"attrs":4098,"content":4099},{"textAlign":53},[4100],{"text":4101,"type":351},"A07: Hypoglycemia",{"type":15,"attrs":4103,"content":4104},{"textAlign":53},[4105],{"text":4106,"type":351},"Concept: Hypoglycemia in diabetic and non-diabetic patients identified during a hospital stay.",{"_uid":4108,"content":4109,"component":585},"3556334f-f082-4a6e-8fcf-ba0cb2445e54",[4110,4196],{"_uid":4111,"content":4112,"component":584},"ad09ffd2-e400-4168-aa01-17ceaa34249c",{"type":12,"content":4113},[4114,4120,4125,4130,4135,4186,4191],{"type":383,"attrs":4115,"content":4116},{"level":385,"textAlign":775},[4117],{"text":957,"type":351,"marks":4118},[4119],{"type":677},{"type":15,"attrs":4121,"content":4122},{"textAlign":53},[4123],{"text":4124,"type":351},"Insulin safety is a key priority nationally for healthcare organizations, the Institute for Safe Medication Practice (ISMP) Canada and provincial governments. There is a growing interest in the adoption of insulin pens in the hospital setting as a means to improve insulin administration safety and ensure continuity of insulin product use by the patient from the community to the hospital setting and at discharge.",{"type":15,"attrs":4126,"content":4127},{"textAlign":775},[4128],{"text":4129,"type":351},"The Pharmacy leaders at the University Health Network (UHN) and Hamilton Health Sciences (HHS) agreed to collaborate for insulin pen implementation in 2013, as both organizations were undertaking conversion to insulin pens at one or more of their sites. The knowledge gained from this project led to the development of a toolkit to provide guidance and stewardship to other healthcare organizations in the safe implementation of insulin pen use in a variety of adult patient care settings.",{"type":15,"attrs":4131,"content":4132},{"textAlign":775},[4133],{"text":4134,"type":351},"The collaboration examined the following:",{"type":438,"content":4136},[4137,4144,4151,4158,4165,4172,4179],{"type":441,"content":4138},[4139],{"type":15,"attrs":4140,"content":4141},{"textAlign":53},[4142],{"text":4143,"type":351},"To evaluate the effectiveness of the toolkit tools in the safe conversion to insulin pens on selected patient care areas at HHS and UHN.",{"type":441,"content":4145},[4146],{"type":15,"attrs":4147,"content":4148},{"textAlign":53},[4149],{"text":4150,"type":351},"To evaluate outcome measures related to insulin administration to further inform healthcare organizations.",{"type":441,"content":4152},[4153],{"type":15,"attrs":4154,"content":4155},{"textAlign":53},[4156],{"text":4157,"type":351},"To evaluate the work flow and workload changes related to conversion from insulin vials and syringes.",{"type":441,"content":4159},[4160],{"type":15,"attrs":4161,"content":4162},{"textAlign":53},[4163],{"text":4164,"type":351},"To facilitate knowledge translation principles of synthesis, dissemination, exchange and application of knowledge to improve health services.",{"type":441,"content":4166},[4167],{"type":15,"attrs":4168,"content":4169},{"textAlign":53},[4170],{"text":4171,"type":351},"To evaluate outcome measures related to insulin administration.",{"type":441,"content":4173},[4174],{"type":15,"attrs":4175,"content":4176},{"textAlign":53},[4177],{"text":4178,"type":351},"To capture lessons learned for the benefit of other healthcare organizations.",{"type":441,"content":4180},[4181],{"type":15,"attrs":4182,"content":4183},{"textAlign":53},[4184],{"text":4185,"type":351},"To develop a best practice education and implementation plan for replication by other healthcare organizations across the country.",{"type":15,"attrs":4187,"content":4188},{"textAlign":775},[4189],{"text":4190,"type":351},"In order to help other organizations embark on the shift in clinical practice to use of insulin pens, UHN and HHS have developed a toolkit within the framework of five guiding dimensions of what is required to successfully achieve such a practice change. This framework is supplemented, in a series of appended documents, with checklists designed as considerations for healthcare organizations to take into account as they contemplate this clinical practice change.",{"type":15,"attrs":4192,"content":4193},{"textAlign":775},[4194],{"text":4195,"type":351},"The framework offered in the toolkit captures the essence of the UHN and HHS experience and is offered from an evidence based perspective as an essential component for successful adoption of clinical practice changes related to insulin administration. (Health Standards Organization, 2015)",{"_uid":4197,"file":4198,"link":4200,"label":4202,"linkType":398,"component":4203,"linkLabel":4204},"32104ff1-31ea-4817-b249-f26cce351257",{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":283,"meta_data":4199},{},{"id":16,"url":4201,"target":597,"linktype":598,"fieldtype":599,"cached_url":4201},"https://accreditation.ca/node/7754","Toolkit for Safe Implementation of Insulin Pens","banner-link","Download the tool",{"_uid":963,"items":4206,"title":1064,"component":641,"description":4323},[4207],{"_uid":966,"title":967,"ctaLeft":4208,"ctaRight":4209,"component":603,"columnLeft":4210,"columnRight":4214},[],[],{"type":12,"content":4211},[4212],{"type":15,"attrs":4213},{"textAlign":53},{"type":12,"content":4215},[4216,4227,4238,4249,4254,4265,4276,4287,4292,4303,4308,4313,4318],{"type":15,"attrs":4217,"content":4218},{"textAlign":53},[4219,4221],{"text":4220,"type":351},"American Diabetes Association (ADA). Diabetes care in the hospital, nursing home, and skilled nursing facility. Diabetes Care. 2015; 38 (Suppl): S80-S85. doi: 10.2337/dc15-S016. ",{"text":4222,"type":351,"marks":4223},"http://care.diabetesjournals.org/content/38/Supplement_1/S80.long",[4224],{"type":398,"attrs":4225},{"href":4222,"uuid":53,"anchor":53,"custom":4226,"target":597,"linktype":598},{},{"type":15,"attrs":4228,"content":4229},{"textAlign":53},[4230,4232],{"text":4231,"type":351},"Canadian Diabetes Association (CDA) Clinical Practice Guidelines Expert Committee, Clayton D, Woo V, Yal JF.  Canadian Diabetes Association 2013 Clinical Practice Guidelines.  Hypoglycemia.  Can J Diabetes. 2013; 37 (suppl 1): S69-S71. doi: 10.1016/j.jcjd.2013.01.022. ",{"text":4233,"type":351,"marks":4234},"http://www.canadianjournalofdiabetes.com/article/S1499-2671(13)00023-3/pdf",[4235],{"type":398,"attrs":4236},{"href":4233,"uuid":53,"anchor":53,"custom":4237,"target":597,"linktype":598},{},{"type":15,"attrs":4239,"content":4240},{"textAlign":53},[4241,4243],{"text":4242,"type":351},"Canadian Diabetes Association (CDA) Clinical Practice Guidelines Expert Committee, Houlden R, Capes S, Clement M, Miller D.  Canadian Diabetes Association 2013 Clinical Practice Guidelines. In-hospital management of diabetes. Can J Diabetes. 2013; 37 (suppl 1): S77-S81. doi:10.1016/j.jcjd.2013.01.024.  ",{"text":4244,"type":351,"marks":4245},"http://www.canadianjournalofdiabetes.com/article/S1499-2671(13)00025-7/pdf",[4246],{"type":398,"attrs":4247},{"href":4244,"uuid":53,"anchor":53,"custom":4248,"target":597,"linktype":598},{},{"type":15,"attrs":4250,"content":4251},{"textAlign":53},[4252],{"text":4253,"type":351},"Cryer PE. Hypoglycemia. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011: chap 34.",{"type":15,"attrs":4255,"content":4256},{"textAlign":53},[4257,4259],{"text":4258,"type":351},"Desimone ME, Weinstock RS. Non-diabetic hypoglycemia. In: De Groot LJ, Beck-Peccoz P, Chrousos G, et al. ed. Endotext. South Dartmouth (MA): MDText.com, Inc.; 2016. ",{"text":4260,"type":351,"marks":4261},"http://www.ncbi.nlm.nih.gov/books/NBK355894/",[4262],{"type":398,"attrs":4263},{"href":4260,"uuid":53,"anchor":53,"custom":4264,"target":597,"linktype":598},{},{"type":15,"attrs":4266,"content":4267},{"textAlign":53},[4268,4270],{"text":4269,"type":351},"Farrokhi F, Klindukhova O, Chandra P, et al. Risk factors for inpatient hypoglycemia during subcutaneous insulin therapy in non-critically ill patients with type 2 diabetes. J Diabetes Sci Technol. 2012; 6 (5): 1022-1029. ",{"text":4271,"type":351,"marks":4272},"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3570835/",[4273],{"type":398,"attrs":4274},{"href":4271,"uuid":53,"anchor":53,"custom":4275,"target":597,"linktype":598},{},{"type":15,"attrs":4277,"content":4278},{"textAlign":53},[4279,4281],{"text":4280,"type":351},"Health Standards Organization (HSO). Toolkit for safe implementation of insulin pens. Health Standards Organization; 2015.  ",{"text":4282,"type":351,"marks":4283},"https://healthstandards.org/leading-practice/toolkit-for-safe-implementation-of-insulin-pens/",[4284],{"type":398,"attrs":4285},{"href":4282,"uuid":53,"anchor":53,"custom":4286,"target":597,"linktype":598},{},{"type":15,"attrs":4288,"content":4289},{"textAlign":53},[4290],{"text":4291,"type":351},"Institute for Healthcare Improvement (IHI).  Reduce adverse drug events involving insulin.  Cambridge, MA: IHI; 2012. http://www.ihi.org/resources/Pages/Changes/ReduceAdverseDrugEventsInvolvingInsulin.aspx",{"type":15,"attrs":4293,"content":4294},{"textAlign":53},[4295,4297],{"text":4296,"type":351},"Institute for Safe Medication Practices (ISMP). List of high-alert medications in acute care settings. Horsham, PA: ISMP; 2016. ",{"text":4298,"type":351,"marks":4299},"https://www.ismp.org/tools/institutionalhighAlert.asp",[4300],{"type":398,"attrs":4301},{"href":4298,"uuid":53,"anchor":53,"custom":4302,"target":597,"linktype":598},{},{"type":15,"attrs":4304,"content":4305},{"textAlign":53},[4306],{"text":4307,"type":351},"Murad MH, Coto-Yglesias F, Wang AT, et al. Drug-induced hypoglycemia: a systematic review. J Clinic Endocrin Metab. 2009; 94 (3): 741-745. doi: 10.1210/jc.2008-1416. http://press.endocrine.org/doi/full/10.1210/jc.2008-1416",{"type":15,"attrs":4309,"content":4310},{"textAlign":53},[4311],{"text":4312,"type":351},"Nirantharakumar K, Marshall T, Kennedy A, Narendran P, Hemming K, Coleman JJ.  Hypoglycaemia is associated with increased length of stay and mortality in people with diabetes who are hospitalized. Diabet Med. 2012; 29 (12): e445-e448. doi: 10.1111/dme.12002.",{"type":15,"attrs":4314,"content":4315},{"textAlign":53},[4316],{"text":4317,"type":351},"Rubin DJ, Golden SH. Hypoglycemia in non-critically ill, hospitalized patients with diabetes: evaluation, prevention, and management. Hosp Pract. 2013; 41 (1): 109-116. doi: 10.3810/hp.2013.02.1016.",{"type":15,"attrs":4319,"content":4320},{"textAlign":53},[4321],{"text":4322,"type":351},"Suzuki Y, Watanabe J, Fukui N, Ozdemir V, Someya T. Hypoglycaemia induced by second generation antipsychotic agents in schizophrenic non-diabetic patients. BMJ. 2009; 338: a1792. doi: 10.1136/bmj.a1792.",{"type":12,"content":4324},[4325],{"type":15},{"id":16,"_uid":4327,"items":4328,"component":1097},"793fe4f4-5dec-4298-b561-ea7483345cbb",[4329],{"_uid":4330,"link":4331,"image":4336,"title":1088,"component":1089,"description":4338},"4b283fe8-fc41-4662-8b85-57768a09b4af",[4332],{"_uid":4333,"link":4334,"label":1082,"component":1083},"57776d57-e977-4838-9082-eb92a1e737dc",{"id":1077,"url":16,"linktype":404,"fieldtype":599,"cached_url":1078,"story":4335},{"name":1080,"id":1081,"uuid":1077,"slug":9,"url":1078,"full_slug":1078,"_stopResolving":291},{"id":1085,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1086,"copyright":16,"fieldtype":283,"meta_data":4337,"is_external_url":285},{},{"type":12,"content":4339},[4340],{"type":15,"attrs":4341,"content":4342},{"textAlign":53},[4343],{"text":1096,"type":351},[129,150,136,122,143,115,157],[185,192,200],"hypoglycemia","resources/hypoglycemia",-18640,[],"a1075af9-fc1a-4848-afdd-957c1377fef9","2025-12-09T18:26:59.288Z",[],[4354],{"path":4355,"name":4356,"lang":305,"published":291},"ressources/hypoglycemie","Hypoglycémie",{"name":4358,"created_at":4359,"published_at":4360,"updated_at":4361,"id":4362,"uuid":4363,"content":4364,"slug":5738,"full_slug":5739,"sort_by_date":53,"position":5740,"tag_list":5741,"is_startpage":285,"parent_id":1105,"meta_data":53,"group_id":5742,"first_published_at":5743,"release_id":53,"lang":299,"path":53,"alternates":5744,"default_full_slug":5739,"translated_slugs":5745},"Wound Disruption","2025-12-09T20:52:36.308Z","2026-03-10T16:38:42.469Z","2026-03-10T16:38:42.575Z",121339725112122,"2edb0313-04e0-47a0-9df0-f75a8f021746",{"new":285,"seo":4365,"_uid":331,"hero":4366,"type":174,"topics":4387,"Noindex":285,"content":4388,"audience":5736,"duration":16,"regional":5737,"component":1100},{"_uid":328,"title":4358,"plugin":329,"og_image":16,"og_title":16,"description":2038,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[4367],{"_uid":334,"image":4368,"title":4370,"format":4371,"component":343,"description":4374,"key_learning":4381,"prerequisite":4384},{"id":336,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":337,"copyright":16,"fieldtype":283,"meta_data":4369,"is_external_url":285},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Wound Disruption",{"type":12,"content":4372},[4373],{"type":15},{"type":12,"content":4375},[4376],{"type":15,"attrs":4377,"content":4378},{"textAlign":53},[4379],{"text":4380,"type":351},"Wound healing is a critical outcome in surgery, and postoperative wound disruption is a serious complication. Surgical incisions are acute wounds that activate the healing process. ",{"type":12,"content":4382},[4383],{"type":15},{"type":12,"content":4385},[4386],{"type":15},[76,8],[4389,4400,4657,4732,5190,5222,5410,5481,5718],{"_uid":361,"link":4390,"image":4391,"title":365,"component":366,"media_type":367,"description":4393},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":283,"meta_data":4392},{},{"type":12,"content":4394},[4395],{"type":15,"attrs":4396,"content":4397},{"textAlign":53},[4398],{"text":4399,"type":351},"Reduce the incidence of wound disruption in surgical and obstetrical patients by assessing risk, implementing risk factor modifications prior to surgery and instituting good wound care management.",{"_uid":376,"content":4401,"component":585},[4402],{"_uid":379,"content":4403,"component":584},{"type":12,"content":4404},[4405,4409,4420,4425,4430,4435,4440,4444,4449,4609,4614],{"type":383,"attrs":4406,"content":4407},{"level":385,"textAlign":53},[4408],{"text":388,"type":351},{"type":15,"attrs":4410,"content":4411},{"textAlign":53},[4412,4413,4419],{"text":393,"type":351},{"text":395,"type":351,"marks":4414},[4415],{"type":398,"attrs":4416},{"href":400,"uuid":401,"anchor":53,"custom":4417,"target":403,"linktype":404,"story":4418},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":410,"type":351},{"type":15,"attrs":4421,"content":4422},{"textAlign":53},[4423],{"text":4424,"type":351},"The healing process has four identified stages, namely: coagulation, inflammation, proliferative phase/granulation tissue formation and the remodeling phase, in reality it is a complex, continuous process (Demidova-Rice et al., 2012). Surgical wound dehiscence (SWD) has been defined as the separation of the margins of a closed surgical incision that has been made in skin, with or without exposure or protrusion of underlying tissue, organs, or implants. Separation may occur at single or multiple regions, or involve the full length of the incision, and may affect some or all tissue layers. A dehisced incision may, or may not, display clinical signs and symptoms of infection (Ousey,2018).",{"type":15,"attrs":4426,"content":4427},{"textAlign":53},[4428],{"text":4429,"type":351},"Despite improvements in contemporary preoperative care and suture materials, the rate of surgical wound disruption has not decreased in recent years (Sorensen et al., 2005). CIHI's Hospital Harm Results reports the number of preventable, unintended harm due to wound disruption as ranged from 3,581 events in fiscal 2014, to 5,435 events in fiscal 2019 (CIHI, 2020). This may be attributable to the increasing incidence of risk factors within the patient population outweighing the benefits of technical achievements (Sorensen et al., 2005).",{"type":15,"attrs":4431,"content":4432},{"textAlign":53},[4433],{"text":4434,"type":351},"The causes of SWD can be categorized as: technical issues with the closure of the incision (e.g., unravelling of suture knots); mechanical stress (e.g., coughing can cause breakage of the sutures or rupture of the healing incision after suture or clip removal/reabsorption); and disrupted healing (e.g., due to comorbidities or treatments that hamper healing, or as a result of a surgical site infection [SSI]) (Ousey, 2018). However, overall SSI is the strongest predictor of wound disruption (Moghadamyeghaneh et al., 2015). Abdominal wound disruption typically occurs at 10 +/- 6.5 days (median eight days) after surgery (Kenig et al., 2014). Hospital stay is significantly longer for patients with wound disruption, with a median of 36 days, compared to 16 days in a control group (van Ramshorst et al., 2010).",{"type":15,"attrs":4436,"content":4437},{"textAlign":53},[4438],{"text":4439,"type":351},"The prevention and management of surgical wound complications is a growing area of concern for patients, healthcare professionals, and administrators alike. In these times of rationalization of healthcare dollars, it is important to ensure that patients receive appropriate screening and care, beginning at the pre-operative assessment and continuing through to post-operative care and monitoring in the community. Best practice recommendations when combined with evidence-informed interventions should help clinicians develop the skills and tools needed to identify those at risk for complications and develop plans in collaboration with their patients to ensure a best practice approach (Harris, 2017).",{"type":383,"attrs":4441,"content":4442},{"level":413,"textAlign":53},[4443],{"text":2122,"type":351},{"type":15,"attrs":4445,"content":4446},{"textAlign":53},[4447],{"text":4448,"type":351},"Factors that could increase the risk of postoperative wound dehiscence (AHRQ-PDI 14, 2016, *Kamel & Khaled, 2014): ",{"type":438,"content":4450},[4451,4579],{"type":441,"content":4452},[4453,4458],{"type":15,"attrs":4454,"content":4455},{"textAlign":53},[4456],{"text":4457,"type":351},"Adult Patient related:",{"type":438,"content":4459},[4460,4467,4474,4481,4488,4495,4502,4509,4516,4523,4530,4537,4544,4551,4558,4565,4572],{"type":441,"content":4461},[4462],{"type":15,"attrs":4463,"content":4464},{"textAlign":53},[4465],{"text":4466,"type":351},"Anemia",{"type":441,"content":4468},[4469],{"type":15,"attrs":4470,"content":4471},{"textAlign":53},[4472],{"text":4473,"type":351},"Hypoproteinemia",{"type":441,"content":4475},[4476],{"type":15,"attrs":4477,"content":4478},{"textAlign":53},[4479],{"text":4480,"type":351},"Jaundice",{"type":441,"content":4482},[4483],{"type":15,"attrs":4484,"content":4485},{"textAlign":53},[4486],{"text":4487,"type":351},"Male gender",{"type":441,"content":4489},[4490],{"type":15,"attrs":4491,"content":4492},{"textAlign":53},[4493],{"text":4494,"type":351},"Overweight",{"type":441,"content":4496},[4497],{"type":15,"attrs":4498,"content":4499},{"textAlign":53},[4500],{"text":4501,"type":351},"Increasing age",{"type":441,"content":4503},[4504],{"type":15,"attrs":4505,"content":4506},{"textAlign":53},[4507],{"text":4508,"type":351},"Infection",{"type":441,"content":4510},[4511],{"type":15,"attrs":4512,"content":4513},{"textAlign":53},[4514],{"text":4515,"type":351},"Episiotomy*",{"type":441,"content":4517},[4518],{"type":15,"attrs":4519,"content":4520},{"textAlign":53},[4521],{"text":4522,"type":351},"Poor nutrition",{"type":441,"content":4524},[4525],{"type":15,"attrs":4526,"content":4527},{"textAlign":53},[4528],{"text":4529,"type":351},"Diabetes",{"type":441,"content":4531},[4532],{"type":15,"attrs":4533,"content":4534},{"textAlign":53},[4535],{"text":4536,"type":351},"Smoking",{"type":441,"content":4538},[4539],{"type":15,"attrs":4540,"content":4541},{"textAlign":53},[4542],{"text":4543,"type":351},"Malignancy",{"type":441,"content":4545},[4546],{"type":15,"attrs":4547,"content":4548},{"textAlign":53},[4549],{"text":4550,"type":351},"Chronic pulmonary disease",{"type":441,"content":4552},[4553],{"type":15,"attrs":4554,"content":4555},{"textAlign":53},[4556],{"text":4557,"type":351},"Presence of prior scar or radiation at the incision site",{"type":441,"content":4559},[4560],{"type":15,"attrs":4561,"content":4562},{"textAlign":53},[4563],{"text":4564,"type":351},"Non-compliance with postoperative instructions (such as early excessive exercise or lifting heavy objects)",{"type":441,"content":4566},[4567],{"type":15,"attrs":4568,"content":4569},{"textAlign":53},[4570],{"text":4571,"type":351},"Increased pressure within the abdomen due to fluid accumulation (ascites); 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Hear her story of overcoming this difficult situation. ",[4723],{"type":2256,"attrs":4724},{"color":2721},{"type":12,"content":4726},[4727],{"type":15,"attrs":4728,"content":4729},{"textAlign":53},[4730],{"text":4731,"type":351},"Wound complications are a burden for patients, their families, and the healthcare system (Butcher & White, 2014).  Poor healing can result in wound disruption which not only affects the patient's quality of life, but may also delay adjuvant therapies, increase post-operative discomfort, delay return to activity, and increase costs as a result of re-intervention, longer hospitalization and readmission. Pain, particularly during dressing change remains a significant factor. Apart from the distress caused, pain can lead to feelings of anxiety, anger, and depression (Woo, 2010). Accurate pain assessment and understanding of the type of pain, helps with decisions about when and how to give analgesia and what information needs to be shared with the multidisciplinary team (Taylor, 2010). Several risk factors can be mitigated before, during and after the operative period, suggesting that the risk of developing wound disruption in vulnerable patients also can be reduced.",{"_uid":650,"items":4733,"title":765,"component":641,"description":5150},[4734],{"_uid":653,"title":654,"ctaLeft":4735,"ctaRight":4736,"component":603,"columnLeft":4737,"columnRight":4756},[],[],{"type":12,"content":4738},[4739],{"type":15,"attrs":4740,"content":4741},{"textAlign":53},[4742,4746,4752],{"text":2253,"type":351,"marks":4743},[4744],{"type":2256,"attrs":4745},{"color":2258},{"text":2260,"type":351,"marks":4747},[4748],{"type":398,"attrs":4749},{"href":400,"uuid":401,"anchor":53,"custom":4750,"target":403,"linktype":404,"story":4751},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":672,"type":351,"marks":4753},[4754],{"type":2256,"attrs":4755},{"color":2258},{"type":12,"content":4757},[4758,4763],{"type":15,"attrs":4759,"content":4760},{"textAlign":53},[4761],{"text":4762,"type":351},"If your review reveals that your cases of wound disruption are linked to specific processes or procedures, you may find these resources helpful:",{"type":438,"content":4764},[4765,4821,4849,4877,4906,4933,4955,4981,5009,5038,5066,5108,5122],{"type":441,"content":4766},[4767,4779],{"type":15,"attrs":4768,"content":4769},{"textAlign":53},[4770,4772],{"text":4771,"type":351},"Agency for Healthcare Research and Quality (AHRQ) ",{"text":4773,"type":351,"marks":4774},"www.ahrq.gov",[4775],{"type":398,"attrs":4776},{"href":4777,"uuid":53,"anchor":53,"custom":4778,"target":597,"linktype":598},"http://www.ahrq.gov",{},{"type":438,"content":4780},[4781,4795,4808],{"type":441,"content":4782},[4783],{"type":15,"attrs":4784,"content":4785},{"textAlign":53},[4786,4788],{"text":4787,"type":351},"Selected Best Practices and Suggestions for Improvement PDI 11: Postoperative Wound Dehiscence [in children]. 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",{"text":4872,"type":351,"marks":4873},"https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.95B11.33135",[4874],{"type":398,"attrs":4875},{"href":4872,"uuid":53,"anchor":53,"custom":4876,"target":597,"linktype":598},{},{"type":441,"content":4878},[4879,4890],{"type":15,"attrs":4880,"content":4881},{"textAlign":53},[4882,4884],{"text":4883,"type":351},"Canadian Journal of Infectious Diseases and Medical Microbiology ",{"text":4885,"type":351,"marks":4886},"https://www.hindawi.com/journals/cjidmm",[4887],{"type":398,"attrs":4888},{"href":4885,"uuid":53,"anchor":53,"custom":4889,"target":597,"linktype":598},{},{"type":438,"content":4891},[4892],{"type":441,"content":4893},[4894],{"type":15,"attrs":4895,"content":4896},{"textAlign":53},[4897,4899],{"text":4898,"type":351},"Chow AW, Evans GA, Nathens AB, et al. Canadian practice guidelines for surgical intra-abdominal infections. 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Infect Control Hosp Epidemiol. 2014;35(6):605-627. doi:10.1086/676022 ",{"text":5061,"type":351,"marks":5062},"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4267723/",[5063],{"type":398,"attrs":5064},{"href":5061,"uuid":53,"anchor":53,"custom":5065,"target":597,"linktype":598},{},{"type":441,"content":5067},[5068,5080],{"type":15,"attrs":5069,"content":5070},{"textAlign":53},[5071,5073],{"text":5072,"type":351},"Wound Care Canada ",{"text":5074,"type":351,"marks":5075},"www.woundscanada.ca",[5076],{"type":398,"attrs":5077},{"href":5078,"uuid":53,"anchor":53,"custom":5079,"target":597,"linktype":598},"http://www.woundscanada.ca",{},{"type":438,"content":5081},[5082,5095],{"type":441,"content":5083},[5084],{"type":15,"attrs":5085,"content":5086},{"textAlign":53},[5087,5089],{"text":5088,"type":351},"Orsted HL, Keast DH, Kuhnke J et al. Best practice recommendations for the prevention and management of open surgical wounds. Wound Care Canada. 2010; 8 (1): 6-34. 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A supplement of Wound Care Canada; 2017. 66 pp. Retrieved from: ",{"text":5103,"type":351,"marks":5104},"https://www.woundscanada.ca/docman/public/health-care-professional/bpr-workshop/555-bpr-prevention-and-management-of-surgical-wound-complications-v2/file",[5105],{"type":398,"attrs":5106},{"href":5103,"uuid":53,"anchor":53,"custom":5107,"target":597,"linktype":598},{},{"type":441,"content":5109},[5110],{"type":15,"attrs":5111,"content":5112},{"textAlign":53},[5113,5115],{"text":5114,"type":351},"Wounds Australia: ",{"text":5116,"type":351,"marks":5117},"Wounds Australia Homepage - Healing Wounds Together",[5118],{"type":398,"attrs":5119},{"href":5120,"uuid":53,"anchor":53,"custom":5121,"target":597,"linktype":598},"https://www.woundsaustralia.com.au/",{},{"type":441,"content":5123},[5124,5135],{"type":15,"attrs":5125,"content":5126},{"textAlign":53},[5127,5129],{"text":5128,"type":351},"Wounds International ",{"text":5130,"type":351,"marks":5131},"www.woundsinternational.com",[5132],{"type":398,"attrs":5133},{"href":5134,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},"http://www.woundsinternational.com",{"type":438,"content":5136},[5137],{"type":441,"content":5138},[5139],{"type":15,"attrs":5140,"content":5141},{"textAlign":53},[5142,5144],{"text":5143,"type":351},"Ousey K, Djohan R, Dowsett C, Ferreira F, Hurd T, Romanelli M, Sandy-Hodgetts K. World Union of Wound Healing Societies (WUWHS) Consensus Document. Surgical wound dehiscence: improving prevention and outcomes. Wounds International, 2018. ",{"text":5145,"type":351,"marks":5146},"https://www.woundsinternational.com/download/resource/7394",[5147],{"type":398,"attrs":5148},{"href":5145,"uuid":53,"anchor":53,"custom":5149,"target":597,"linktype":598},{},{"type":12,"content":5151},[5152,5157,5161,5188],{"type":15,"attrs":5153,"content":5154},{"textAlign":53},[5155],{"text":5156,"type":351},"Given the broad range of potential causes of wound disruption, in addition to recommendations listed above, we recommend conducting clinical and system reviews to identify latent causes and determine appropriate recommendations.",{"type":15,"attrs":5158,"content":5159},{"textAlign":775},[5160],{"text":778,"type":351},{"type":780,"attrs":5162,"content":5163},{"order":782},[5164,5170,5176,5182],{"type":441,"content":5165},[5166],{"type":15,"attrs":5167,"content":5168},{"textAlign":53},[5169],{"text":790,"type":351},{"type":441,"content":5171},[5172],{"type":15,"attrs":5173,"content":5174},{"textAlign":53},[5175],{"text":797,"type":351},{"type":441,"content":5177},[5178],{"type":15,"attrs":5179,"content":5180},{"textAlign":53},[5181],{"text":804,"type":351},{"type":441,"content":5183},[5184],{"type":15,"attrs":5185,"content":5186},{"textAlign":53},[5187],{"text":811,"type":351},{"type":15,"attrs":5189},{"textAlign":775},{"_uid":813,"items":5191,"title":858,"component":859,"description":5216},[5192,5198,5204,5210],{"_uid":835,"image":5193,"title":1629,"component":822,"description":5195},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":5194,"is_external_url":285},{},{"type":12,"content":5196},[5197],{"type":15},{"_uid":827,"image":5199,"title":830,"component":822,"description":5201},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":5200,"is_external_url":285},{},{"type":12,"content":5202},[5203],{"type":15},{"_uid":816,"image":5205,"title":821,"component":822,"description":5207},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":5206,"is_external_url":285},{},{"type":12,"content":5208},[5209],{"type":15},{"_uid":843,"image":5211,"title":838,"component":822,"description":5213},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":5212,"is_external_url":285},{},{"type":12,"content":5214},[5215],{"type":15},{"type":12,"content":5217},[5218],{"type":15,"attrs":5219,"content":5220},{"textAlign":53},[5221],{"text":1657,"type":351},{"_uid":868,"items":5223,"title":890,"component":641,"description":5382},[5224,5285,5347],{"_uid":871,"title":872,"ctaLeft":5225,"ctaRight":5226,"component":603,"columnLeft":5227,"columnRight":5231},[],[],{"type":12,"content":5228},[5229],{"type":15,"attrs":5230},{"textAlign":53},{"type":12,"content":5232},[5233,5240],{"type":15,"attrs":5234,"content":5235},{"textAlign":53},[5236,5239],{"text":2708,"type":351,"marks":5237},[5238],{"type":677},{"text":2712,"type":351},{"type":438,"content":5241},[5242,5249,5256,5271],{"type":441,"content":5243},[5244],{"type":15,"attrs":5245,"content":5246},{"textAlign":53},[5247],{"text":5248,"type":351},"O90.002: Identified as diagnosis type (M), (1), (2), (W), (X) or (Y)",{"type":441,"content":5250},[5251],{"type":15,"attrs":5252,"content":5253},{"textAlign":53},[5254],{"text":5255,"type":351},"O90.102: Identified as diagnosis type (M), (1), (2), (W), (X) or (Y)",{"type":441,"content":5257},[5258],{"type":15,"attrs":5259,"content":5260},{"textAlign":53},[5261,5263,5266,5268],{"text":5262,"type":351},"T81.3: Identified as diagnosis type (2) ",{"text":3968,"type":351,"marks":5264},[5265],{"type":677},{"text":5267,"type":351},"Y60–Y84 ",{"text":3974,"type":351,"marks":5269},[5270],{"type":677},{"type":441,"content":5272},[5273],{"type":15,"attrs":5274,"content":5275},{"textAlign":53},[5276,5278,5281,5282],{"text":5277,"type":351},"T81.83*: Identified as diagnosis type (2) 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complication",{"type":441,"content":5315},[5316],{"type":15,"attrs":5317,"content":5318},{"textAlign":53},[5319,5323],{"text":5320,"type":351,"marks":5321},"O90.102",[5322],{"type":677},{"text":5324,"type":351},": Disruption of perineal obstetric wound, delivered with mention of postpartum complication",{"type":441,"content":5326},[5327],{"type":15,"attrs":5328,"content":5329},{"textAlign":53},[5330,5334],{"text":5331,"type":351,"marks":5332},"T81.3",[5333],{"type":677},{"text":5335,"type":351},": Disruption of operation wound, not elsewhere classified",{"type":441,"content":5337},[5338],{"type":15,"attrs":5339,"content":5340},{"textAlign":53},[5341,5345],{"text":5342,"type":351,"marks":5343},"T81.83*",[5344],{"type":677},{"text":5346,"type":351},": Postoperative leak",{"_uid":1743,"title":1744,"ctaLeft":5348,"ctaRight":5349,"component":603,"columnLeft":5350,"columnRight":5354},[],[],{"type":12,"content":5351},[5352],{"type":15,"attrs":5353},{"textAlign":53},{"type":12,"content":5355},[5356,5365,5380],{"type":15,"attrs":5357,"content":5358},{"textAlign":53},[5359,5363],{"text":5360,"type":351,"marks":5361},"Additional Codes",[5362],{"type":677},{"text":5364,"type":351},": Inclusions",{"type":438,"content":5366},[5367],{"type":441,"content":5368},[5369],{"type":15,"attrs":5370,"content":5371},{"textAlign":53},[5372,5374,5379],{"text":5373,"type":351},"Y60-Y84: Complications of medical and surgical care (refer to Appendix A) of the ",{"text":1778,"type":351,"marks":5375},[5376],{"type":398,"attrs":5377},{"href":1782,"uuid":53,"anchor":53,"custom":5378,"target":597,"linktype":598},{},{"text":1763,"type":351},{"type":15,"attrs":5381},{"textAlign":53},{"type":12,"content":5383},[5384,5388,5401],{"type":15,"attrs":5385,"content":5386},{"textAlign":53},[5387],{"text":1790,"type":351},{"type":438,"content":5389},[5390],{"type":441,"content":5391},[5392],{"type":15,"attrs":5393,"content":5394},{"textAlign":53},[5395,5399],{"text":5396,"type":351,"marks":5397},"D23",[5398],{"type":677},{"text":5400,"type":351},": Would Disruption",{"type":15,"attrs":5402,"content":5403},{"textAlign":53},[5404,5408],{"text":5405,"type":351,"marks":5406},"Concept",[5407],{"type":677},{"text":5409,"type":351},": Disruption of surgical wound during the same hospital stay or an obstetric wound during the delivery episode of care.",{"_uid":904,"items":5411,"title":957,"component":641,"description":5477},[5412,5435,5457],{"_uid":907,"title":5413,"ctaLeft":5414,"ctaRight":5415,"component":603,"columnLeft":5421,"columnRight":5428},"Wound Care Distance Consulting ",[],[5416],{"_uid":5417,"link":5418,"label":5420,"component":601},"c1934137-2603-4787-928e-d9574e5a5961",{"id":16,"url":5419,"target":597,"linktype":598,"fieldtype":599,"cached_url":5419},"https://healthstandards.org/leading-practice/wound-care-distance-consulting/","Read the report",{"type":12,"content":5422},[5423],{"type":15,"attrs":5424,"content":5425},{"textAlign":53},[5426],{"text":5427,"type":351},"HSO Health Standards Organization, 2009",{"type":12,"content":5429},[5430],{"type":15,"attrs":5431,"content":5432},{"textAlign":53},[5433],{"text":5434,"type":351},"St. Adolphe Personal Care Home, a rural long-term care home, takes photos of difficult to heal wounds and e-mails them to a consulting dermatologist in the city. With this visual aid, the home's physician receives a more meaningful consult and has been successful in healing advanced ulcers. The consulting dermatologist has endorsed this practice and encourages other rural homes to adopt it. ",{"_uid":933,"title":5436,"ctaLeft":5437,"ctaRight":5438,"component":603,"columnLeft":5443,"columnRight":5450},"Pixalere Incision Module",[],[5439],{"_uid":5440,"link":5441,"label":5420,"component":601},"b4da11ed-d092-4ad4-979b-0d108375b2fc",{"id":16,"url":5442,"target":597,"linktype":598,"fieldtype":599,"cached_url":5442},"https://healthstandards.org/leading-practice/pixalere-incision-module/",{"type":12,"content":5444},[5445],{"type":15,"attrs":5446,"content":5447},{"textAlign":53},[5448],{"text":5449,"type":351},"HSO Health Standards Organization, 2010",{"type":12,"content":5451},[5452],{"type":15,"attrs":5453,"content":5454},{"textAlign":53},[5455],{"text":5456,"type":351},"Wound care is an ongoing, important issue with many home care clients. The efforts and resources provided by the home care staff using the Pixalere system, together with the support and consultation of RNs with specialized training in wound care management, have resulted in the Home Health program providing leading edge care. The ability to track a client's progress through a series of digital photos along with a clinical narrative allows staff to make appropriate and timely changes to care plans, helping to ensure quality patient outcomes.",{"_uid":5458,"title":5459,"ctaLeft":5460,"ctaRight":5461,"component":603,"columnLeft":5466,"columnRight":5470},"cc5a2cb9-4d7e-47e0-8384-4eb4c6086c14","Wounds Australia",[],[5462],{"_uid":5463,"link":5464,"label":4667,"component":601},"ec2825d1-4e91-41b6-99a7-e03f53d976e3",{"id":16,"url":5465,"target":597,"linktype":598,"fieldtype":599,"cached_url":5465},"https://www.youtube.com/watch?v=Y0nDdcLVHdA",{"type":12,"content":5467},[5468],{"type":15,"attrs":5469},{"textAlign":53},{"type":12,"content":5471},[5472],{"type":15,"attrs":5473,"content":5474},{"textAlign":53},[5475],{"text":5476,"type":351},"Pharmacist describes his experience with a long-standing, chronic leg ulcer and eventually receiving a new approach to care that was successful. ",{"type":12,"content":5478},[5479],{"type":15,"attrs":5480},{"textAlign":53},{"_uid":963,"items":5482,"title":1064,"component":641,"description":5714},[5483],{"_uid":966,"title":5484,"ctaLeft":5485,"ctaRight":5486,"component":603,"columnLeft":5487,"columnRight":5491},"Expand to see the full list of references",[],[],{"type":12,"content":5488},[5489],{"type":15,"attrs":5490},{"textAlign":53},{"type":12,"content":5492},[5493,5505,5516,5527,5541,5558,5575,5585,5595,5611,5622,5639,5650,5664,5681,5698],{"type":15,"attrs":5494,"content":5495},{"textAlign":53},[5496,5498,5500],{"text":5497,"type":351},"AHRQ PDI 11 - Selected Best Practices and Suggestions for Improvement PDI 11: Postoperative Wound Dehiscence [in children]. Toolkit for using the AHRQ quality indicators: How to Improve Hospital Quality and Safety. AHRQ, 2016 #5",{"type":5499},"hard_break",{"text":4793,"type":351,"marks":5501},[5502,5504],{"type":398,"attrs":5503},{"href":4793,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":5506,"content":5507},{"textAlign":775},[5508,5510,5511],{"text":5509,"type":351},"AHRQ PSI 14 - Selected Best Practices and Suggestions for Improvement PSI 14: Postoperative Wound Dehiscence [in adults] Toolkit for using the AHRQ quality indicators: How to Improve Hospital Quality and Safety. AHRQ, 2016 #6. ",{"type":5499},{"text":4803,"type":351,"marks":5512},[5513,5515],{"type":398,"attrs":5514},{"href":4803,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":5517,"content":5518},{"textAlign":775},[5519,5521,5525],{"text":5520,"type":351},"Butcher M, White R. Factors affecting cost-effectiveness in wound care decision making. ",{"text":5522,"type":351,"marks":5523},"Nurs Stand",[5524],{"type":1417},{"text":5526,"type":351},". 2014; 28 (35): 51-58. doi: 10.7748/ns2014.04.28.35.51.e7671.",{"type":15,"attrs":5528,"content":5529},{"textAlign":775},[5530,5532,5539],{"text":5531,"type":351},"Canadian Institute for Health Information. ",{"text":5533,"type":351,"marks":5534},"Hospital Harm Results",[5535,5538],{"type":398,"attrs":5536},{"href":5537,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},"https://www.cihi.ca/sites/default/files/document/hospital-harm-results-2014-2022-data-tables-en.xlsx",{"type":2267},{"text":5540,"type":351},", 2014–2015 to 2019–2020. Ottawa, ON: CIHI; 2020.",{"type":15,"attrs":5542,"content":5543},{"textAlign":775},[5544,5546,5550,5552],{"text":5545,"type":351},"Demidova-Rice T, Hamblin M, Herman IM. Acute and impaired wound healing: pathophysiology and current methods for drug delivery, part 1: normal and chronic wounds: biology, causes, and approaches to care. ",{"text":5547,"type":351,"marks":5548},"Adv Skin Wound Care",[5549],{"type":1417},{"text":5551,"type":351},". 2012; 25 (7): 304-314. doi: 10.1097/01.ASW.0000416006.55218.d0. ",{"text":5553,"type":351,"marks":5554},"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3428147/",[5555,5557],{"type":398,"attrs":5556},{"href":5553,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":5559,"content":5560},{"textAlign":775},[5561,5563,5567,5569],{"text":5562,"type":351},"Harris CL, Kuhnke J, Haley J, Cross K, Somayaji R, Dubois J, et al. ",{"text":5564,"type":351,"marks":5565},"Best practice recommendations for the prevention and management of surgical wound complications. ",[5566],{"type":1417},{"text":5568,"type":351},"In: Foundations of Best Practice for Skin and Wound Management. A supplement of Wound Care Canada; 2017. 66 pp. Retrieved from: ",{"text":5570,"type":351,"marks":5571},"www.woundscanada.ca/docman/public/health-care-professional/bpr-workshop/555-bpr-prevention-and-management-of-surgical-wound-complications-v2/file",[5572,5574],{"type":398,"attrs":5573},{"href":5103,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":5576,"content":5577},{"textAlign":775},[5578,5580],{"text":5579,"type":351},"Health Standards Organization, 2009 , Leading Practices Library, Wound Care Distance Consulting. ",{"text":5419,"type":351,"marks":5581},[5582,5584],{"type":398,"attrs":5583},{"href":5419,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":5586,"content":5587},{"textAlign":775},[5588,5590],{"text":5589,"type":351},"Health Standards Organization, 2010 , Leading Practices Library. Pixalere Incision Module. ",{"text":5442,"type":351,"marks":5591},[5592,5594],{"type":398,"attrs":5593},{"href":5442,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":5596,"content":5597},{"textAlign":775},[5598,5600,5604,5606],{"text":5599,"type":351},"Institute for Healthcare Improvement (IHI). ",{"text":5601,"type":351,"marks":5602},"How-to Guide: Prevent surgical site infections.",[5603],{"type":1417},{"text":5605,"type":351}," Cambridge, MA: IHI; 2012. ",{"text":4976,"type":351,"marks":5607},[5608,5610],{"type":398,"attrs":5609},{"href":4976,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":5612,"content":5613},{"textAlign":775},[5614,5616,5620],{"text":5615,"type":351},"Kamel A, Khaled  M. Episiotomy, and obstetric perineal wound dehiscence: Beyond soreness. ",{"text":5617,"type":351,"marks":5618},"J Obstet Gynaecol",[5619],{"type":1417},{"text":5621,"type":351},". 2014; 34 (3): 215-217. doi: 10.3109/01443615.2013.866080.",{"type":15,"attrs":5623,"content":5624},{"textAlign":775},[5625,5627,5631,5633],{"text":5626,"type":351},"Kenig J, Richer P, Lasek A, Zbierska K, Zurawska S. The efficacy of risk scores for predicting abdominal wound dehiscence: a case – controlled validation study. ",{"text":5628,"type":351,"marks":5629},"BMC Surg",[5630],{"type":1417},{"text":5632,"type":351},". 2014; 14: 65. doi: 10.1186/1471-2482-14-65. ",{"text":5634,"type":351,"marks":5635},"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4159378/",[5636,5638],{"type":398,"attrs":5637},{"href":5634,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":5640,"content":5641},{"textAlign":775},[5642,5644,5648],{"text":5643,"type":351},"Moghadamyeghaneh Z, Hanna MH, Carmichael JC, et al. Wound disruption following colorectal operations. ",{"text":5645,"type":351,"marks":5646},"World J Surg",[5647],{"type":1417},{"text":5649,"type":351},". 2015; 39(12): 2999-3007. doi: 10.1007/s00268-015-3208-0.",{"type":15,"attrs":5651,"content":5652},{"textAlign":775},[5653,5655,5662],{"text":5654,"type":351},"Ousey K, Djohan R, Dowsett C, Ferreira F, Hurd T, Romanelli M, Sandy-Hodgetts K. World Union of Wound Healing Societies (WUWHS) Consensus Document. ",{"text":5656,"type":351,"marks":5657},"Surgical wound dehiscence: improving prevention and outcomes",[5658,5661],{"type":398,"attrs":5659},{"href":5660,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},"https://woundsinternational.com/consensus-documents/surgical-wound-dehiscence-improving-prevention-and-outcomes/",{"type":2267},{"text":5663,"type":351},". Wounds International, 2018.",{"type":15,"attrs":5665,"content":5666},{"textAlign":775},[5667,5669,5673,5675],{"text":5668,"type":351},"Sorensen L, Hemmingsen U, Kallehave F, et al. Risk factors for tissue and wound complications in gastrointestinal surgery. ",{"text":5670,"type":351,"marks":5671},"Ann Surg",[5672],{"type":1417},{"text":5674,"type":351},". 2005; 241 (4): 654-658. ",{"text":5676,"type":351,"marks":5677},"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1357070/",[5678,5680],{"type":398,"attrs":5679},{"href":5676,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":5682,"content":5683},{"textAlign":775},[5684,5686,5690,5692],{"text":5685,"type":351},"Taylor A. Principles of pain assessment. ",{"text":5687,"type":351,"marks":5688},"Wound Essentials",[5689],{"type":1417},{"text":5691,"type":351},". 2010; 5: 104-110. ",{"text":5693,"type":351,"marks":5694},"https://www.wounds-uk.com/download/resource/1155",[5695,5697],{"type":398,"attrs":5696},{"href":5693,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":5699,"content":5700},{"textAlign":775},[5701,5703,5706,5708],{"text":5702,"type":351},"van Ramshorst G, Nieuwenhuizen J, Hop WC, et al. Abdominal wound dehiscence in adults: Development and validation of a risk model. ",{"text":5645,"type":351,"marks":5704},[5705],{"type":1417},{"text":5707,"type":351},". 2010; 34 (1): 20-27. doi: 10.1007/s00268-009-0277-y. ",{"text":5709,"type":351,"marks":5710},"http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2795859/",[5711,5713],{"type":398,"attrs":5712},{"href":5709,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":12,"content":5715},[5716],{"type":15,"attrs":5717},{"textAlign":53},{"id":16,"_uid":5719,"items":5720,"component":1097},"b2d6641a-1c3b-4864-ba6c-19ee346da1d3",[5721],{"_uid":5722,"link":5723,"image":5728,"title":1088,"component":1089,"description":5730},"c7cfed08-2efd-4485-aa1e-73f8e8102be3",[5724],{"_uid":5725,"link":5726,"label":1082,"component":1083},"9ad5d873-9318-46d0-a224-c392ff477445",{"id":1077,"url":16,"linktype":404,"fieldtype":599,"cached_url":1078,"story":5727},{"name":1080,"id":1081,"uuid":1077,"slug":9,"url":1078,"full_slug":1078,"_stopResolving":291},{"id":1085,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1086,"copyright":16,"fieldtype":283,"meta_data":5729,"is_external_url":285},{},{"type":12,"content":5731},[5732],{"type":15,"attrs":5733,"content":5734},{"textAlign":53},[5735],{"text":1096,"type":351},[129,150,136,122,143,115,157],[185,192,200],"wound-disruption","resources/wound-disruption",-18650,[],"83a94f81-990a-4d3d-a6a6-aca10bb374b8","2025-12-09T21:48:41.399Z",[],[5746],{"path":5747,"name":5748,"lang":305,"published":291},"ressources/rupture-d-une-plaie","Rupture d’une plaie",{"name":5750,"created_at":5751,"published_at":5752,"updated_at":5753,"id":5754,"uuid":5755,"content":5756,"slug":6520,"full_slug":6521,"sort_by_date":53,"position":6522,"tag_list":6523,"is_startpage":285,"parent_id":1105,"meta_data":53,"group_id":6524,"first_published_at":6525,"release_id":53,"lang":299,"path":53,"alternates":6526,"default_full_slug":6521,"translated_slugs":6527},"Pneumonia","2025-12-09T22:18:30.884Z","2026-03-10T16:37:55.403Z","2026-03-10T16:37:55.452Z",121360838247228,"56694c39-163e-4316-afc6-5453abb4f101",{"new":285,"seo":5757,"_uid":331,"hero":5758,"type":174,"topics":5779,"Noindex":285,"content":5780,"audience":6518,"duration":16,"regional":6519,"component":1100},{"_uid":328,"title":5750,"plugin":329,"og_image":16,"og_title":16,"description":2038,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[5759],{"_uid":334,"image":5760,"title":5762,"format":5763,"component":343,"description":5766,"key_learning":5773,"prerequisite":5776},{"id":336,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":337,"copyright":16,"fieldtype":283,"meta_data":5761,"is_external_url":285},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Pneumonia",{"type":12,"content":5764},[5765],{"type":15},{"type":12,"content":5767},[5768],{"type":15,"attrs":5769,"content":5770},{"textAlign":53},[5771],{"text":5772,"type":351},"Pneumonia is an infection of the lungs defined as the presence of \"new lung infiltrate plus clinical evidence that the infiltrate is of an infectious origin, which include the new onset of fever, purulent sputum, leukocytosis, and decline in oxygenation\" (Kalil et al., 2016). Pneumonia can be caused by viruses, bacteria, and fungi and can cause mild to severe illness in people of all ages and (Centers for Disease Control and Prevention (CDC), 2020).",{"type":12,"content":5774},[5775],{"type":15},{"type":12,"content":5777},[5778],{"type":15},[76,8],[5781,5792,5915,5954,6156,6188,6390,6411,6500],{"_uid":361,"link":5782,"image":5783,"title":365,"component":366,"media_type":367,"description":5785},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":283,"meta_data":5784},{},{"type":12,"content":5786},[5787],{"type":15,"attrs":5788,"content":5789},{"textAlign":53},[5790],{"text":5791,"type":351},"To prevent hospital-acquired pneumonia in hospitalized adult patients by implementing proven interventions.",{"_uid":376,"content":5793,"component":585},[5794],{"_uid":379,"content":5795,"component":584},{"type":12,"content":5796},[5797,5801,5812,5817,5840,5845,5850,5855,5860,5865,5870,5875,5880,5910],{"type":383,"attrs":5798,"content":5799},{"level":385,"textAlign":53},[5800],{"text":388,"type":351},{"type":15,"attrs":5802,"content":5803},{"textAlign":53},[5804,5805,5811],{"text":393,"type":351},{"text":395,"type":351,"marks":5806},[5807],{"type":398,"attrs":5808},{"href":400,"uuid":401,"anchor":53,"custom":5809,"target":403,"linktype":404,"story":5810},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":410,"type":351},{"type":15,"attrs":5813,"content":5814},{"textAlign":53},[5815],{"text":5816,"type":351},"For pneumonia to occur in any setting, at least one of the following three conditions must occur:",{"type":438,"content":5818},[5819,5826,5833],{"type":441,"content":5820},[5821],{"type":15,"attrs":5822,"content":5823},{"textAlign":53},[5824],{"text":5825,"type":351},"significant impairment of host defenses,",{"type":441,"content":5827},[5828],{"type":15,"attrs":5829,"content":5830},{"textAlign":53},[5831],{"text":5832,"type":351},"introduction of an inoculum of sufficient size into the lower respiratory tract to overwhelm the host's defenses, or",{"type":441,"content":5834},[5835],{"type":15,"attrs":5836,"content":5837},{"textAlign":53},[5838],{"text":5839,"type":351},"the presence of highly virulent organisms (Centre for Communicable Diseases and Infection Control, 2010).",{"type":15,"attrs":5841,"content":5842},{"textAlign":53},[5843],{"text":5844,"type":351},"Despite advances in the understanding of contributing causes and prevention, hospital acquired pneumonia (HAP) and ventilator associated pneumonia (VAP) continue to be frequent complications of hospital care. Together, they are among the most common hospital-acquired infections (HAIs), accounting for 22 per cent of all HAIs (Kalil et al., 2016).",{"type":383,"attrs":5846,"content":5847},{"level":413,"textAlign":53},[5848],{"text":5849,"type":351},"Hospital-acquired pneumonia (HAP)",{"type":15,"attrs":5851,"content":5852},{"textAlign":53},[5853],{"text":5854,"type":351},"HAP is an acute lower respiratory tract infection that is, by definition, acquired after at least 48 hours of admission to the hospital and is not incubating at the time of admission. Among patients with hospital-acquired infections, HAP is the leading cause of death and causes 22% of all hospital-acquired infections. Though generally considered to be less severe than ventilator-associated pneumonia (VAP), even in HAP serious complications occur in approximately 50% of patients, including respiratory failure, pleural effusions, septic shock, renal failure, and empyema (Kalil et al., 2016).",{"type":383,"attrs":5856,"content":5857},{"level":413,"textAlign":53},[5858],{"text":5859,"type":351},"Ventilator-associated pneumonia (VAP)",{"type":15,"attrs":5861,"content":5862},{"textAlign":53},[5863],{"text":5864,"type":351},"Ventilator-associated pneumonia (VAP) is defined by infection of the pulmonary parenchyma in patients exposed to invasive mechanical ventilation for at least 48 hours and is part of ICU-acquired pneumonia. VAP remains one of the most common infections in patients requiring invasive mechanical ventilation.",{"type":15,"attrs":5866,"content":5867},{"textAlign":53},[5868],{"text":5869,"type":351},"VAP is reported to affect five to 40 per cent of patients receiving invasive mechanical ventilation for more than two days (Papazian et al., 2020). Compared to similar patients without VAP, these infections negatively impact important patient outcomes and prolong both the length of mechanical ventilation and hospitalization (Kalil et al., 2016). Kalil et al. indicate that while all-cause mortality associated with VAP has been reported to range from 20 to 50 per cent, the mortality directly related to VAP is debated (2016).",{"type":383,"attrs":5871,"content":5872},{"level":413,"textAlign":53},[5873],{"text":5874,"type":351},"Risk of Transmission",{"type":15,"attrs":5876,"content":5877},{"textAlign":53},[5878],{"text":5879,"type":351},"In all healthcare settings, there is significant risk of transmission of acute respiratory infection (ARI) to patients and to healthcare providers. This is due to:",{"type":438,"content":5881},[5882,5889,5896,5903],{"type":441,"content":5883},[5884],{"type":15,"attrs":5885,"content":5886},{"textAlign":53},[5887],{"text":5888,"type":351},"the large number of people (i.e., patients, family members, volunteers, visitors, workers) who come and go in these settings;",{"type":441,"content":5890},[5891],{"type":15,"attrs":5892,"content":5893},{"textAlign":53},[5894],{"text":5895,"type":351},"the ease with which droplet-spread respiratory illnesses can pass from one person to another;",{"type":441,"content":5897},[5898],{"type":15,"attrs":5899,"content":5900},{"textAlign":53},[5901],{"text":5902,"type":351},"the fact that many clients/patients/residents have other illnesses that make them more likely to experience complications from respiratory infections; and",{"type":441,"content":5904},[5905],{"type":15,"attrs":5906,"content":5907},{"textAlign":53},[5908],{"text":5909,"type":351},"the large number of people who seek care for or develop ARI in these settings",{"type":15,"attrs":5911,"content":5912},{"textAlign":53},[5913],{"text":5914,"type":351},"(Provincial Infectious Diseases Advisory Committee (PIDAC), 2013)",{"_uid":1359,"content":5916,"component":585},[5917],{"_uid":1362,"content":5918,"component":584},{"type":12,"content":5919},[5920,5924,5929,5934,5939,5944,5949],{"type":383,"attrs":5921,"content":5922},{"level":385,"textAlign":53},[5923],{"text":640,"type":351},{"type":15,"attrs":5925,"content":5926},{"textAlign":53},[5927],{"text":5928,"type":351},"Hospital-acquired pneumonia, and notably ventilator-associated pneumonia, developing as a consequence of lung bacterial colonization, alters clinically important outcomes, including duration of mechanical ventilation, length of stay in the intensive care unit (ICU), and mortality rates (Kalil et al., 2016; Roquilly et al., 2015).",{"type":15,"attrs":5930,"content":5931},{"textAlign":53},[5932],{"text":5933,"type":351},"VAP is one of the most serious complications for the most critically ill and vulnerable patients and can be avoided in the hospital by using proven strategies (Institute for Healthcare Improvement (IHI), 2012).",{"type":15,"attrs":5935,"content":5936},{"textAlign":53},[5937],{"text":5938,"type":351},"Vaccines can prevent some types of Pneumonia. Patients can help prevent pneumonia and other respiratory infections by following good hygiene practices. These practices include cleaning hands regularly and disinfecting frequently touched surfaces (CDC, 2020).",{"type":383,"attrs":5940,"content":5941},{"level":413,"textAlign":53},[5942],{"text":5943,"type":351},"Patient Story",{"type":15,"attrs":5945,"content":5946},{"textAlign":53},[5947],{"text":5948,"type":351},"Claire inspires change after her passing.",{"type":15,"attrs":5950,"content":5951},{"textAlign":53},[5952],{"text":5953,"type":351},"Claire, the nine year- old daughter of an ICU nurse, died after 16 days in the same intensive care, following surgery to repair a malformation in her skull. After surgery, Claire was placed in a deep sleep and on a ventilator. She eventually succumbed to complications, including pneumonia. Her mother risked everything to fight in Claire's memory. A review of Claire's care found that ventilator management was below accepted standards. It also revealed Claire's death was precipitated by an abrupt rise in carbon dioxide caused, most commonly, by a blocked endotracheal tube. The review deemed Claire's death as preventable (Canadian Patient Safety Institute, 2011).",{"_uid":650,"items":5955,"title":765,"component":641,"description":6115},[5956],{"_uid":653,"title":654,"ctaLeft":5957,"ctaRight":5958,"component":603,"columnLeft":5959,"columnRight":5972},[],[],{"type":12,"content":5960},[5961],{"type":15,"attrs":5962,"content":5963},{"textAlign":53},[5964,5965,5971],{"text":2253,"type":351},{"text":2260,"type":351,"marks":5966},[5967],{"type":398,"attrs":5968},{"href":400,"uuid":401,"anchor":53,"custom":5969,"target":403,"linktype":404,"story":5970},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":672,"type":351},{"type":12,"content":5973},[5974,5985,5990,5997,6022,6029,6045,6052,6066,6073,6082,6089],{"type":15,"attrs":5975,"content":5976},{"textAlign":53},[5977,5978,5984],{"text":663,"type":351},{"text":665,"type":351,"marks":5979},[5980],{"type":398,"attrs":5981},{"href":400,"uuid":401,"anchor":53,"custom":5982,"target":403,"linktype":404,"story":5983},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":1450,"type":351},{"type":15,"attrs":5986,"content":5987},{"textAlign":53},[5988],{"text":5989,"type":351},"If your review reveals that pneumonia-related events are linked to specific processes or procedures, you may find these resources helpful:",{"type":15,"attrs":5991,"content":5992},{"textAlign":53},[5993],{"text":5994,"type":351,"marks":5995},"Association for Professionals in Infection Control and Epidemiology, Inc. 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America",[6088],{"type":677},{"type":438,"content":6090},[6091,6103],{"type":441,"content":6092},[6093],{"type":15,"attrs":6094,"content":6095},{"textAlign":53},[6096],{"text":6097,"type":351,"marks":6098},"Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and non-ventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update",[6099],{"type":398,"attrs":6100},{"href":6101,"uuid":53,"anchor":53,"custom":6102,"target":597,"linktype":598},"https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/strategies-to-prevent-ventilatorassociated-pneumonia-ventilatorassociated-events-and-nonventilator-hospitalacquired-pneumonia-in-acutecare-hospitals-2022-update/A2124BA9B088027AE30BE46C28887084",{},{"type":441,"content":6104},[6105],{"type":15,"attrs":6106,"content":6107},{"textAlign":53},[6108],{"text":6109,"type":351,"marks":6110},"SHEA/IDSA Strategies to Prevent Ventilator-Associated Pneumonia in Acute Care 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Pneumonia due to other specified infectious organisms",{"type":15,"attrs":6321,"content":6322},{"textAlign":53},[6323,6327],{"text":6324,"type":351,"marks":6325},"J18.–",[6326],{"type":677},{"text":6328,"type":351},": Pneumonia, organism unspecified",{"type":15,"attrs":6330,"content":6331},{"textAlign":53},[6332,6336],{"text":6333,"type":351,"marks":6334},"J85.1",[6335],{"type":677},{"text":6337,"type":351},": Abscess of lung with pneumonia",{"_uid":1743,"title":1744,"ctaLeft":6339,"ctaRight":6340,"component":603,"columnLeft":6341,"columnRight":6347},[],[],{"type":12,"content":6342},[6343,6345],{"type":15,"attrs":6344},{"textAlign":53},{"type":15,"attrs":6346},{"textAlign":53},{"type":12,"content":6348},[6349,6358],{"type":15,"attrs":6350,"content":6351},{"textAlign":53},[6352,6356],{"text":6353,"type":351,"marks":6354},"J95.88",[6355],{"type":677},{"text":6357,"type":351},": Other post-procedural respiratory disorders Includes: Ventilator associated pneumonia (VAP)",{"type":15,"attrs":6359,"content":6360},{"textAlign":53},[6361,6364,6366,6371],{"text":3083,"type":351,"marks":6362},[6363],{"type":677},{"text":6365,"type":351},": Complications of medical and surgical care(refer to Appendix A of the ",{"text":1778,"type":351,"marks":6367},[6368],{"type":398,"attrs":6369},{"href":3345,"uuid":53,"anchor":53,"custom":6370,"target":597,"linktype":598},{},{"text":3095,"type":351},{"type":12,"content":6373},[6374,6382],{"type":15,"attrs":6375,"content":6376},{"textAlign":53},[6377,6378],{"text":1790,"type":351},{"text":6379,"type":351,"marks":6380},"B16: Pneumonia",[6381],{"type":677},{"type":15,"attrs":6383,"content":6384},{"textAlign":53},[6385,6388],{"text":5405,"type":351,"marks":6386},[6387],{"type":677},{"text":6389,"type":351},": Pneumonia identified during a hospital 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A concern about high HAP rates on the neurosurgical ward at Royal Columbian Hospital (RCH) was identified by the Clinical Nurse Specialist (CNS). A multidisciplinary team was formed, led by the CNS and a Speech Language Pathologist (SLP) (Health Standards Organization, 2015)",{"_uid":963,"items":6412,"title":1064,"component":641,"description":6497},[6413],{"_uid":966,"title":967,"ctaLeft":6414,"ctaRight":6415,"component":603,"columnLeft":6416,"columnRight":6422},[],[],{"type":12,"content":6417},[6418,6420],{"type":15,"attrs":6419},{"textAlign":53},{"type":15,"attrs":6421},{"textAlign":53},{"type":12,"content":6423},[6424,6429,6441,6453,6465,6470,6475,6480,6485],{"type":15,"attrs":6425,"content":6426},{"textAlign":53},[6427],{"text":6428,"type":351},"Canadian Patient Safety Institute. Claire inspires change after her passing. Published 2011. ",{"type":15,"attrs":6430,"content":6431},{"textAlign":53},[6432,6434],{"text":6433,"type":351},"Centre for Communicable Diseases and Infection Control. Infection Control Guideline for the Prevention of Healthcare-Associated Pneumonia. Ottawa, ON: Public Health Agency of Canada; 2010. ",{"text":6435,"type":351,"marks":6436},"http://publications.gc.ca/collections/collection_2012/aspc-phac/HP40-54-2010-eng.pdf ",[6437],{"type":398,"attrs":6438},{"href":6439,"uuid":53,"anchor":53,"custom":6440,"target":597,"linktype":598},"https://publications.gc.ca/site/archivee-archived.html?url=https%3A%2F%2Fpublications.gc.ca%2Fcollections%2Fcollection_2012%2Faspc-phac%2FHP40-54-2010-eng.pdf",{},{"type":15,"attrs":6442,"content":6443},{"textAlign":53},[6444,6446],{"text":6445,"type":351},"Centers for Disease Control and Prevention (CDC). Pneumonia. CDC. Published March 9, 2020. ",{"text":6447,"type":351,"marks":6448},"http://www.cdc.gov/pneumonia/index.html ",[6449],{"type":398,"attrs":6450},{"href":6451,"uuid":53,"anchor":53,"custom":6452,"target":597,"linktype":598},"https://www.cdc.gov/pneumonia/index.html",{},{"type":15,"attrs":6454,"content":6455},{"textAlign":53},[6456,6458],{"text":6457,"type":351},"Health Standards Organization. Leading Practices Library. Accreditation Canada. Published 2015. ",{"text":6459,"type":351,"marks":6460},"https://accreditation.ca/leading-practices ",[6461],{"type":398,"attrs":6462},{"href":6463,"uuid":53,"anchor":53,"custom":6464,"target":597,"linktype":598},"https://accreditation.ca/leading-practices/",{},{"type":15,"attrs":6466,"content":6467},{"textAlign":53},[6468],{"text":6469,"type":351},"Institute for Healthcare Improvement (IHI). How-to Guide: Prevent Ventilator-Associated Pneumonia. Cambridge, MA: IHI; 2012. http://www.ihi.org/resources/Pages/Tools/HowtoGuidePreventVAP.aspx ",{"type":15,"attrs":6471,"content":6472},{"textAlign":53},[6473],{"text":6474,"type":351},"Kalil AC, Metersky ML, Klompas M, et al. Management of Adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-e111. doi:10.1093/cid/ciw353 ",{"type":15,"attrs":6476,"content":6477},{"textAlign":53},[6478],{"text":6479,"type":351},"Papazian L, Klompas M, Luyt C-E. Ventilator-associated pneumonia in adults: A narrative review. Intensive Care Medicine. March 2020. doi:10.1007/s00134-020-05980-0",{"type":15,"attrs":6481,"content":6482},{"textAlign":53},[6483],{"text":6484,"type":351},"Provincial Infectious Diseases Advisory Committee (PIDAC). Annex B: Best Practices for Prevention of Transmission of Acute Respiratory Infection In All Health Care Settings. Toronto, ON: Public Health Ontario; 2013. https://www.publichealthontario.ca/-/media/documents/bp-prevention-transmission-ari.pdf?la=en ",{"type":15,"attrs":6486,"content":6487},{"textAlign":53},[6488,6490],{"text":6489,"type":351},"Roquilly A, Marret E, Abraham E, Asehnoune K. Pneumonia prevention to decrease mortality in intensive care unit: a systematic review and meta-analysis. Clin Infect Dis. 2015;60(1):64-75. doi:10.1093/cid/ciu740. [Erratum: Roquilly et al. Clin Infect Dis 2015; 60: 64-75]. ",{"text":6491,"type":351,"marks":6492},"http://cid.oxfordjournals.org/content/60/1/64.full.pdf",[6493],{"type":398,"attrs":6494},{"href":6495,"uuid":53,"anchor":53,"custom":6496,"target":597,"linktype":598},"https://academic.oup.com/cid/article-abstract/60/1/64/2895643?redirectedFrom=fulltext",{},{"type":12,"content":6498},[6499],{"type":15},{"id":16,"_uid":6501,"items":6502,"component":1097},"40924503-5ad6-48eb-b352-b225f0df68da",[6503],{"_uid":6504,"link":6505,"image":6510,"title":1088,"component":1089,"description":6512},"1ced0c12-2798-4968-bb15-6cd41d8a454a",[6506],{"_uid":6507,"link":6508,"label":1082,"component":1083},"b0d98062-7e82-42f8-a0f7-3f26e855db4b",{"id":1077,"url":16,"linktype":404,"fieldtype":599,"cached_url":1078,"story":6509},{"name":1080,"id":1081,"uuid":1077,"slug":9,"url":1078,"full_slug":1078,"_stopResolving":291},{"id":1085,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1086,"copyright":16,"fieldtype":283,"meta_data":6511,"is_external_url":285},{},{"type":12,"content":6513},[6514],{"type":15,"attrs":6515,"content":6516},{"textAlign":53},[6517],{"text":1096,"type":351},[129,150,136,122,143,115,157],[185,192,200],"pneumonia","resources/pneumonia",-18660,[],"088138fa-0e16-4ede-b351-209a08f78584","2025-12-09T22:46:17.781Z",[],[6528],{"path":6529,"name":6530,"lang":305,"published":291},"ressources/pneumonie","Pneumonie",{"name":6532,"created_at":6533,"published_at":6534,"updated_at":6535,"id":6536,"uuid":6537,"content":6538,"slug":8052,"full_slug":8053,"sort_by_date":53,"position":8054,"tag_list":8055,"is_startpage":285,"parent_id":1105,"meta_data":53,"group_id":8056,"first_published_at":8057,"release_id":53,"lang":299,"path":53,"alternates":8058,"default_full_slug":8053,"translated_slugs":8059},"Post Procedural Infections","2025-12-10T13:59:27.705Z","2026-03-10T16:36:53.170Z","2026-03-10T16:36:53.240Z",121592085574467,"767a19b8-88f1-4959-aeca-98152956d6c3",{"new":285,"seo":6539,"_uid":331,"hero":6540,"type":174,"topics":6564,"Noindex":285,"content":6565,"audience":8050,"duration":16,"regional":8051,"component":1100},{"_uid":328,"title":6532,"plugin":329,"og_image":16,"og_title":16,"description":2038,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[6541],{"_uid":334,"image":6542,"title":6544,"format":6545,"component":343,"description":6548,"key_learning":6558,"prerequisite":6561},{"id":336,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":337,"copyright":16,"fieldtype":283,"meta_data":6543,"is_external_url":285},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Post Procedural Infections",{"type":12,"content":6546},[6547],{"type":15},{"type":12,"content":6549},[6550],{"type":15,"attrs":6551,"content":6552},{"textAlign":53},[6553],{"text":6554,"type":351,"marks":6555},"A Post Procedure infection is associated with a medical or surgical procedure and results from colonization with a bacterial load greater than the capability of the immune system to manage. These infections can significantly increase cost, morbidity and even mortality.",[6556],{"type":2256,"attrs":6557},{"color":2721},{"type":12,"content":6559},[6560],{"type":15},{"type":12,"content":6562},[6563],{"type":15},[76,8],[6566,6577,6614,6672,7351,7383,7830,7863,8032],{"_uid":361,"link":6567,"image":6568,"title":365,"component":366,"media_type":367,"description":6570},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":283,"meta_data":6569},{},{"type":12,"content":6571},[6572],{"type":15,"attrs":6573,"content":6574},{"textAlign":53},[6575],{"text":6576,"type":351},"To prevent post procedural infections and deaths in hospitalized patients by reliably implementing evidence-based procedural care for all patients undergoing invasive procedures.",{"_uid":376,"content":6578,"component":585},[6579],{"_uid":379,"content":6580,"component":584},{"type":12,"content":6581},[6582,6586,6597,6602,6607,6612],{"type":383,"attrs":6583,"content":6584},{"level":385,"textAlign":53},[6585],{"text":388,"type":351},{"type":15,"attrs":6587,"content":6588},{"textAlign":53},[6589,6590,6596],{"text":393,"type":351},{"text":395,"type":351,"marks":6591},[6592],{"type":398,"attrs":6593},{"href":400,"uuid":401,"anchor":53,"custom":6594,"target":403,"linktype":404,"story":6595},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":410,"type":351},{"type":15,"attrs":6598,"content":6599},{"textAlign":53},[6600],{"text":6601,"type":351},"Surgical site infections (SSIs) are infections of the incision, or organ, or space that occur after surgery. Surgical patients initially seen with more complex comorbidities and the emergence of antimicrobial-resistant pathogens increase the cost and challenge of treating SSIs. The prevention of SSI is increasingly important as the number of surgical procedures performed … continues to rise. It has been estimated that approximately half of SSIs are preventable by application of evidence-based strategies (Berríos-Torres et al., 2017). SSIs affect up to one-third of patients who have undergone a surgical procedure (World Health Organization, 2018). Surgical site infections are a frequent cause of morbidity following surgical procedures and  have also been shown to increase mortality, readmission rates, length of stay, and costs for patients who incur them. (Cataife et al., 2014).",{"type":15,"attrs":6603,"content":6604},{"textAlign":53},[6605],{"text":6606,"type":351},"The pooled incidence of SSIs in low- and middle-income countries is 11.8 per 100 surgical procedures. Although it is much lower in high-income countries, it remains the second most frequent type of healthcare-associated infections (HAI) in Europe and the United States of America (USA). The highest cumulative incidence was for colon surgery with 9.5 per cent episodes per 100 operations, followed by 3.5 per cent for coronary artery bypass graft, 2.9 per cent for caesarean section, 1.4 per cent for cholecystectomy, 1.0 per cent for hip prosthesis, 0.8 per cent for laminectomy and 0.75 per cent for knee prosthesis (WHO, 2018).",{"type":15,"attrs":6608,"content":6609},{"textAlign":53},[6610],{"text":6611,"type":351},"Many factors in a patient's journey through surgery have been identified as contributing to the risk of SSI. The prevention of these infections is complex and requires the integration of a range of measures before, during and after surgery (WHO, 2018).",{"type":15,"attrs":6613},{"textAlign":53},{"_uid":587,"items":6615,"title":640,"component":641,"description":6655},[6616,6635],{"_uid":590,"title":6617,"ctaLeft":6618,"ctaRight":6619,"component":603,"columnLeft":6624,"columnRight":6628},"Ginny's Story",[],[6620],{"_uid":6621,"link":6622,"label":4667,"component":601},"bb7ac13b-79e5-4293-a6c9-13d340ec53fa",{"id":16,"url":6623,"target":597,"linktype":598,"fieldtype":599,"cached_url":6623},"https://www.youtube.com/watch?v=s5x1f3_NJX8",{"type":12,"content":6625},[6626],{"type":15,"attrs":6627},{"textAlign":53},{"type":12,"content":6629},[6630],{"type":15,"attrs":6631,"content":6632},{"textAlign":53},[6633],{"text":6634,"type":351},"Ginny's life was changed forever by a preventable hospital-acquired infection.",{"_uid":6636,"title":6637,"ctaLeft":6638,"ctaRight":6639,"component":603,"columnLeft":6644,"columnRight":6648},"5ef0d9a6-9e1e-4c94-b978-490b98e13f92","One Is Too Many: Viewing Infection Data from the Patient's Perspective",[],[6640],{"_uid":6641,"link":6642,"label":6637,"component":601},"0666c8d3-6124-4c78-bded-a0f61c0e90ed",{"id":16,"url":6643,"target":597,"linktype":598,"fieldtype":599,"cached_url":6643},"http://www.ihi.org/resources/Pages/AudioandVideo/OneIsTooManyViewingInfectionDatafromPatientsPerspective.aspx",{"type":12,"content":6645},[6646],{"type":15,"attrs":6647},{"textAlign":53},{"type":12,"content":6649},[6650],{"type":15,"attrs":6651,"content":6652},{"textAlign":53},[6653],{"text":6654,"type":351},"A surgical patient who contracted MRSA following knee replacement surgery describes the effects of the surgical site infection (SSI) on her life, and how her experience led her health care providers to make changes to prevent SSIs. ",{"type":12,"content":6656},[6657,6662,6667],{"type":15,"attrs":6658,"content":6659},{"textAlign":53},[6660],{"text":6661,"type":351},"Skin is a natural barrier against infection. Even with many precautions and protocols to prevent infection in place, any surgery that causes a break in the skin can lead to an infection (Johns Hopkins Medicine, n.d.). When patients get an infection following surgery or procedure, it delays healing, extends the patient's length of stay and increases their risk for harm and readmission. By implementing the appropriate interventions, patients are safer and go home sooner (Institute for Healthcare Improvement, n.d.).",{"type":15,"attrs":6663,"content":6664},{"textAlign":53},[6665],{"text":6666,"type":351},"Most patients who have surgery do well, but about three out of every 100 surgery patients get an infection. This can lead to other problems such as a longer hospital stay and rarely, an infection-related death (IHI, 2012).",{"type":15,"attrs":6668,"content":6669},{"textAlign":53},[6670],{"text":6671,"type":351},"Patients and carers should be given information and advice on how to care for their wound after discharge, how to recognize a surgical site infection, and who to contact if they are concerned (NICE, 2019).",{"_uid":650,"items":6673,"title":765,"component":641,"description":7311},[6674],{"_uid":653,"title":654,"ctaLeft":6675,"ctaRight":6676,"component":603,"columnLeft":6677,"columnRight":6696},[],[],{"type":12,"content":6678},[6679],{"type":15,"attrs":6680,"content":6681},{"textAlign":53},[6682,6686,6692],{"text":2253,"type":351,"marks":6683},[6684],{"type":2256,"attrs":6685},{"color":2258},{"text":2260,"type":351,"marks":6687},[6688],{"type":398,"attrs":6689},{"href":400,"uuid":401,"anchor":53,"custom":6690,"target":403,"linktype":404,"story":6691},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":672,"type":351,"marks":6693},[6694],{"type":2256,"attrs":6695},{"color":2258},{"type":12,"content":6697},[6698,6703],{"type":15,"attrs":6699,"content":6700},{"textAlign":53},[6701],{"text":6702,"type":351},"If your review reveals that your cases of Post Procedural Infections are linked to specific processes or procedures, you may find these resources helpful:",{"type":438,"content":6704},[6705,6736,6765,6859,6890,6918,6964,7016,7044,7072,7121,7155,7199,7242,7276],{"type":441,"content":6706},[6707,6718],{"type":15,"attrs":6708,"content":6709},{"textAlign":53},[6710,6712],{"text":6711,"type":351},"American Journal of Health-System Pharmacy",{"text":6713,"type":351,"marks":6714}," https://academic.oup.com/ajhp",[6715,6717],{"type":398,"attrs":6716},{"href":4829,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":438,"content":6719},[6720],{"type":441,"content":6721},[6722],{"type":15,"attrs":6723,"content":6724},{"textAlign":53},[6725,6727,6731],{"text":6726,"type":351},"Bratzler DW, Dellinger EP, Olsen KM, et al. 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Infection of obstetric surgical wound; delivered with mention of postpartum 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Complication of reattached (part of) upper extremity; infection",{"type":441,"content":7731},[7732],{"type":15,"attrs":7733,"content":7734},{"textAlign":53},[7735,7738],{"text":7566,"type":351,"marks":7736},[7737],{"type":677},{"text":7739,"type":351},": Complications of reattached (part of) lower extremity; infection",{"type":441,"content":7741},[7742],{"type":15,"attrs":7743,"content":7744},{"textAlign":53},[7745,7748],{"text":7583,"type":351,"marks":7746},[7747],{"type":677},{"text":7749,"type":351},": Infection of other reattached body part",{"type":441,"content":7751},[7752],{"type":15,"attrs":7753,"content":7754},{"textAlign":53},[7755,7758],{"text":7600,"type":351,"marks":7756},[7757],{"type":677},{"text":7759,"type":351},": Infection of amputation stump",{"_uid":1743,"title":1744,"ctaLeft":7761,"ctaRight":7762,"component":603,"columnLeft":7763,"columnRight":7767},[],[],{"type":12,"content":7764},[7765],{"type":15,"attrs":7766},{"textAlign":53},{"type":12,"content":7768},[7769,7776],{"type":15,"attrs":7770,"content":7771},{"textAlign":53},[7772,7775],{"text":5360,"type":351,"marks":7773},[7774],{"type":677},{"text":5364,"type":351},{"type":438,"content":7777},[7778],{"type":441,"content":7779},[7780],{"type":15,"attrs":7781,"content":7782},{"textAlign":53},[7783,7787,7789],{"text":7784,"type":351,"marks":7785},"Y60-Y84",[7786],{"type":677},{"text":7788,"type":351},": Complications of medical and surgical care (refer to Appendix A) of the ",{"text":1778,"type":351,"marks":7790},[7791],{"type":398,"attrs":7792},{"href":1782,"uuid":53,"anchor":53,"custom":7793,"target":403,"linktype":598},{},{"type":12,"content":7795},[7796,7800,7813,7821],{"type":15,"attrs":7797,"content":7798},{"textAlign":53},[7799],{"text":1790,"type":351},{"type":438,"content":7801},[7802],{"type":441,"content":7803},[7804],{"type":15,"attrs":7805,"content":7806},{"textAlign":53},[7807,7811],{"text":7808,"type":351,"marks":7809},"B14",[7810],{"type":677},{"text":7812,"type":351},": Post Procedural Infections",{"type":15,"attrs":7814,"content":7815},{"textAlign":53},[7816,7819],{"text":5405,"type":351,"marks":7817},[7818],{"type":677},{"text":7820,"type":351},": Infections associated with a medical or surgical procedure.",{"type":15,"attrs":7822,"content":7823},{"textAlign":53},[7824,7828],{"text":7825,"type":351,"marks":7826},"Notes",[7827],{"type":677},{"text":7829,"type":351},": This clinical group may include inflammatory reactions in the absence of infection.",{"_uid":7831,"content":7832,"component":585},"5d74840d-8140-4d06-a1bb-46e735184517",[7833,7855],{"_uid":7834,"content":7835,"component":584},"8b89c40b-1e60-4131-ace9-d4840e8aabe7",{"type":12,"content":7836},[7837,7841,7846,7851],{"type":383,"attrs":7838,"content":7839},{"level":385,"textAlign":53},[7840],{"text":957,"type":351},{"type":383,"attrs":7842,"content":7843},{"level":413,"textAlign":53},[7844],{"text":7845,"type":351},"HSO Leading Practices Library",{"type":15,"attrs":7847,"content":7848},{"textAlign":53},[7849],{"text":7850,"type":351},"Healthcare associated infections are considered a serious threat to the hospitalized patient's safety. Among surgical site infections, those related to orthopaedic procedures are considered severe and can increase morbidity-mortality rates. Factors in the preoperative, intraoperative, and postoperative periods that can help prevent orthopaedic infections include good preoperative skin care, optimal care during the operative phase, high rates of hand hygiene compliance throughout the continuum of care, stringent aseptic technique with postoperative dressing changes and the reduction of any incision site complications such as blisters. In the pre-operative period, the goal is effective skin preparation to reduce the resident microbial count and is achieved by having patients shower using Chlorhexidine 2 per cent, eliminating shaving, and screening for antibiotic resistant organisms such as MRSA. In the operative phase, the administration and timing of prophylactic antibiotics are crucial to the reduction of infection rates. Timing was improved by having Nurses start the infusion when the previous patient leaves the OR. The dose of the antibiotic Ancef was increased from 1 to 2 gms, and antibiotic impregnated cement (methyl methacrylate) was introduced. Perioperative normothermia has been shown to help decrease infections in orthopaedic patients so all patients are provided with warming blankets. Hand Hygiene is considered the single most important way to reduce nosocomial infections. Holland Centre compliances rates went from 28 per cent in 2008 to 85 per cent in 2012 with education, increased access to hand wash stations and products at Point-of-Care. We also now have full compliance with staff not wearing hand or arm jewelry and not eating and drinking in the nursing stations. These two factors are known to decrease infection rates. The introduction of a new wound care product and protocol, reduced the need for dressing changes, allowed greater flexibility for patients mobilizing and showering after surgery, and reduced blistering around the wound. The Holland Centre performs over 2,100 Total Joint procedures annually. A comprehensive process is in place to monitor and report infection rates for 12 months following surgery. In 2011/12 surgical infection rate in total hip and knee replacement patients was 0.00 per cent (compared to the National Healthcare Safety Network (NHSN) target rates of 0.75 per cent for hips and 0.68 per cent for knees). Preliminary data for 2012/13 shows that the program has sustained a 0.00 per cent infection rate for both hip and knee patients. We continually strive to improve practice throughout the entire process in order to eliminate surgical site infections in our patient population.",{"type":15,"attrs":7852,"content":7853},{"textAlign":53},[7854],{"text":1763,"type":351},{"_uid":7856,"file":7857,"link":7859,"label":7861,"linkType":398,"component":4203,"linkLabel":7862},"7a0dc658-8ff9-4ca0-8861-5f09f23ab22a",{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":283,"meta_data":7858},{},{"id":16,"url":7860,"target":597,"linktype":598,"fieldtype":599,"cached_url":7860},"https://healthstandards.org/leading-practice/best-practice-in-infection-prevention-and-control-in-a-surgical-patient-population/","Best Practice in Infection Prevention and Control in a Surgical Patient Population (Health Standards Organization, 2013)","Download the report",{"_uid":963,"items":7864,"title":1064,"component":641,"description":8028},[7865],{"_uid":966,"title":967,"ctaLeft":7866,"ctaRight":7867,"component":603,"columnLeft":7868,"columnRight":7872},[],[],{"type":12,"content":7869},[7870],{"type":15,"attrs":7871},{"textAlign":53},{"type":12,"content":7873},[7874,7883,7900,7911,7926,7936,7950,7961,7971,7983,7998,8015],{"type":15,"attrs":7875,"content":7876},{"textAlign":53},[7877,7878,7881],{"text":6938,"type":351},{"text":6940,"type":351,"marks":7879},[7880],{"type":1417},{"text":7882,"type":351},". 2017;152(8):784-791. doi:10.1001/jamasurg.2017.0904",{"type":15,"attrs":7884,"content":7885},{"textAlign":775},[7886,7888,7892,7894],{"text":7887,"type":351},"Canadian Institute for Health Information. Appendix A. In: ",{"text":7889,"type":351,"marks":7890},"Hospital Harm Indicator: General Methodology Notes",[7891],{"type":1417},{"text":7893,"type":351},". Canadian Institute for Health Information; 2019. ",{"text":7895,"type":351,"marks":7896},"https://indicatorlibrary.cihi.ca/display/HSPIL/Hospital+Harm?preview=/10453027/15564910/Hospital%20Harm%20Indicator%20General%20Methodology%20Notes.pdf",[7897,7899],{"type":398,"attrs":7898},{"href":7895,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":7901,"content":7902},{"textAlign":775},[7903,7905,7909],{"text":7904,"type":351},"Cataife G, Weinberg DA, Wong H-H, Kahn KL. The Effect of Surgical Care Improvement Project (SCIP) Compliance on Surgical Site Infections (SSI). ",{"text":7906,"type":351,"marks":7907},"Med Care",[7908],{"type":1417},{"text":7910,"type":351},". 2014;52 (2 Suppl 1): S66-S73. doi: 10.1097/MLR.0000000000000028.",{"type":15,"attrs":7912,"content":7913},{"textAlign":775},[7914,7916,7919,7921],{"text":7915,"type":351},"Health Care for All. ",{"text":6617,"type":351,"marks":7917},[7918],{"type":1417},{"text":7920,"type":351},". 2008. Accessed February 2021. ",{"text":6623,"type":351,"marks":7922},[7923,7925],{"type":398,"attrs":7924},{"href":6623,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":7927,"content":7928},{"textAlign":775},[7929,7931],{"text":7930,"type":351},"Health Standards Organization. Best Practice in Infection Prevention and Control in a Surgical Patient Population. HSO Leading Practices Library. Published 2013. ",{"text":7860,"type":351,"marks":7932},[7933,7935],{"type":398,"attrs":7934},{"href":7860,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":7937,"content":7938},{"textAlign":775},[7939,7941,7944,7945],{"text":7940,"type":351},"Institute for Healthcare Improvement (IHI). ",{"text":7093,"type":351,"marks":7942},[7943],{"type":1417},{"text":7097,"type":351},{"text":4976,"type":351,"marks":7946},[7947,7949],{"type":398,"attrs":7948},{"href":4976,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":7951,"content":7952},{"textAlign":775},[7953,7955],{"text":7954,"type":351},"Institute for Healthcare Improvement. One Is Too Many: Viewing Infection Data from the Patient's Perspective. Published 2016. ",{"text":7956,"type":351,"marks":7957},"http://www.ihi.org:80/resources/Pages/AudioandVideo/OneIsTooManyViewingInfectionDatafromPatientsPerspective.aspx",[7958,7960],{"type":398,"attrs":7959},{"href":6643,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":7962,"content":7963},{"textAlign":775},[7964,7965,7969],{"text":7940,"type":351},{"text":7966,"type":351,"marks":7967},"IHI Improvement Map",[7968],{"type":1417},{"text":7970,"type":351},". IHI; n.d. (Out of print)",{"type":15,"attrs":7972,"content":7973},{"textAlign":775},[7974,7976],{"text":7975,"type":351},"Johns Hopkins Medicine. Surgical Site Infections. Health: Conditions and Diseases. Accessed February 2021.",{"text":7977,"type":351,"marks":7978}," https://www.hopkinsmedicine.org/health/conditions-and-diseases/surgical-site-infections",[7979,7982],{"type":398,"attrs":7980},{"href":7981,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},"https://www.hopkinsmedicine.org/health/conditions-and-diseases/surgical-site-infections",{"type":2267},{"type":15,"attrs":7984,"content":7985},{"textAlign":775},[7986,7987,7991,7993],{"text":7186,"type":351},{"text":7988,"type":351,"marks":7989},"NICE Surgical Site Infections: Prevention and Treatment.",[7990],{"type":1417},{"text":7992,"type":351}," NICE; 2019. ",{"text":5004,"type":351,"marks":7994},[7995,7997],{"type":398,"attrs":7996},{"href":5004,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"type":15,"attrs":7999,"content":8000},{"textAlign":775},[8001,8003,8007,8009],{"text":8002,"type":351},"Public Health Agency of Canada. ",{"text":8004,"type":351,"marks":8005},"Routine Practices and Additional Precautions for Preventing the Transmission of Infection in Healthcare Settings",[8006],{"type":1417},{"text":8008,"type":351},". Public Health Agency of Canada; 2012. ",{"text":8010,"type":351,"marks":8011},"http://publications.gc.ca/collections/collection_2013/aspc-phac/HP40-83-2013-eng.pdf",[8012,8014],{"type":398,"attrs":8013},{"href":8010,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":15,"attrs":8016,"content":8017},{"textAlign":775},[8018,8019,8022,8023],{"text":7298,"type":351},{"text":7300,"type":351,"marks":8020},[8021],{"type":1417},{"text":7304,"type":351},{"text":7306,"type":351,"marks":8024},[8025,8027],{"type":398,"attrs":8026},{"href":7306,"uuid":53,"anchor":53,"custom":53,"target":597,"linktype":598},{"type":2267},{"type":12,"content":8029},[8030],{"type":15,"attrs":8031},{"textAlign":53},{"id":16,"_uid":8033,"items":8034,"component":1097},"70a219c1-6fc3-485b-8930-b922bea7deba",[8035],{"_uid":8036,"link":8037,"image":8042,"title":1088,"component":1089,"description":8044},"38f7ece4-620a-463b-99b4-2316228eaa55",[8038],{"_uid":8039,"link":8040,"label":1082,"component":1083},"cbf091ce-d9da-43af-8a8c-3289d9318c7a",{"id":1077,"url":16,"linktype":404,"fieldtype":599,"cached_url":1078,"story":8041},{"name":1080,"id":1081,"uuid":1077,"slug":9,"url":1078,"full_slug":1078,"_stopResolving":291},{"id":1085,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1086,"copyright":16,"fieldtype":283,"meta_data":8043,"is_external_url":285},{},{"type":12,"content":8045},[8046],{"type":15,"attrs":8047,"content":8048},{"textAlign":53},[8049],{"text":1096,"type":351},[129,150,136,122,143,115,157],[185,192,200],"post-procedural-infections","resources/post-procedural-infections",-18670,[],"74cc9d5f-1e09-4895-9cec-d826250595d7","2025-12-10T16:54:18.167Z",[],[8060],{"path":8061,"name":8062,"lang":305,"published":291},"ressources/infections-post-intervention","Infections post-intervention",{"name":8064,"created_at":8065,"published_at":8066,"updated_at":8067,"id":8068,"uuid":8069,"content":8070,"slug":8929,"full_slug":8930,"sort_by_date":53,"position":8931,"tag_list":8932,"is_startpage":285,"parent_id":1105,"meta_data":53,"group_id":8933,"first_published_at":8934,"release_id":53,"lang":299,"path":53,"alternates":8935,"default_full_slug":8930,"translated_slugs":8936},"Pneumothorax","2025-12-10T14:45:33.851Z","2026-03-10T16:35:28.838Z","2026-03-10T16:35:28.907Z",121603415573316,"249b8a66-6368-431e-88c1-62637239c334",{"new":285,"seo":8071,"_uid":331,"hero":8072,"type":174,"topics":8093,"Noindex":285,"content":8094,"audience":8927,"duration":16,"regional":8928,"component":1100},{"_uid":328,"title":8064,"plugin":329,"og_image":16,"og_title":16,"description":2038,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[8073],{"_uid":334,"image":8074,"title":8076,"format":8077,"component":343,"description":8080,"key_learning":8087,"prerequisite":8090},{"id":336,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":337,"copyright":16,"fieldtype":283,"meta_data":8075,"is_external_url":285},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Pneumothorax",{"type":12,"content":8078},[8079],{"type":15},{"type":12,"content":8081},[8082],{"type":15,"attrs":8083,"content":8084},{"textAlign":53},[8085],{"text":8086,"type":351},"A pneumothorax is present when there is air in the pleural space. Pneumothoraces are classified as spontaneous, which develop without preceding trauma or other obvious cause, and traumatic, which develop as a result of direct or indirect trauma to the chest. Traumatic pneumothoraces can be either iatrogenic or non-iatrogenic (Light & Lee, 2016). An iatrogenic pneumothorax (IP) is a known complication of invasive procedures such as pulmonary needle biopsy (transthoracic and transbronchial), placement of a central venous line, or positive pressure ventilation. However, this condition can arise from many other procedures involving the thorax and abdomen. Subclavian insertion of a central venous line (CVL) is the most common procedure associated with an iatrogenic pneumothorax (Ojeda Rodriguez & Hipskind, 2021) and is the focus of this indicator.",{"type":12,"content":8088},[8089],{"type":15},{"type":12,"content":8091},[8092],{"type":15},[76,8],[8095,8106,8267,8315,8485,8517,8677,8693,8909],{"_uid":361,"link":8096,"image":8097,"title":365,"component":366,"media_type":367,"description":8099},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":283,"meta_data":8098},{},{"type":12,"content":8100},[8101],{"type":15,"attrs":8102,"content":8103},{"textAlign":53},[8104],{"text":8105,"type":351},"To prevent iatrogenic pneumothorax in hospitalized adult patients by implementing best practices for risk reduction.",{"_uid":376,"content":8107,"component":585},[8108],{"_uid":379,"content":8109,"component":584},{"type":12,"content":8110},[8111,8115,8126,8131,8136,8141,8146,8151,8156,8161,8166,8171,8176,8181,8186,8191,8196,8247,8252,8257,8262],{"type":383,"attrs":8112,"content":8113},{"level":385,"textAlign":53},[8114],{"text":388,"type":351},{"type":15,"attrs":8116,"content":8117},{"textAlign":53},[8118,8119,8125],{"text":393,"type":351},{"text":395,"type":351,"marks":8120},[8121],{"type":398,"attrs":8122},{"href":400,"uuid":401,"anchor":53,"custom":8123,"target":403,"linktype":404,"story":8124},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":410,"type":351},{"type":15,"attrs":8127,"content":8128},{"textAlign":53},[8129],{"text":8130,"type":351},"In the Measuring Patient Harm in Canadian Hospitals, the Canadian Institute for Health Information (CIHI) reported that of the 181,596 harmful events identified in the Data Quality Study of the 2015–2016 Discharge Abstract Database; 1.1 per cent were due to pneumothorax from a medical or surgical procedure (Chan et al., 2016) and 2,100 pneumothoraces were reported in 2019-2020 (CIHI, 2020). AHRQ reports the 2020 rate of IP per 1,000 at 0.19 in the United States (AHRQ, 2020).",{"type":15,"attrs":8132,"content":8133},{"textAlign":53},[8134],{"text":8135,"type":351},"A tension pneumothorax is present when the air accumulates in the pleural space to a point where the increasing pressure impedes normal cardiovascular function. [It] can occur with any of the types of pneumothorax but occur more commonly in patients receiving positive pressure ventilation or CPR [and] can lead - often quite suddenly - to life-threatening hypotension and shock (Light & Lee, 2016).",{"type":15,"attrs":8137,"content":8138},{"textAlign":53},[8139],{"text":8140,"type":351},"Iatrogenic pneumothoraces is a potentially life-threatening complication seen in three per cent of ICU patients (Chen et al., 2002; Anzueto et al., 2004; de Lassence et al., 2006). It has been associated with an increase in ICU and hospital length of stay, and resource utilization (Amato et al., 1998; Anzueto et al., 2004; de Lassence et al., 2006; Zhan et al., 2006), as well as an increase in the risk of death (Gattinoni et al., 1994, Schnapp et al., 1995, Esteban et al., 2002).",{"type":15,"attrs":8142,"content":8143},{"textAlign":53},[8144],{"text":8145,"type":351},"IP is largely preventable (de Lassence et al., 2006). In the ICU setting, the currently low three per cent incidence of IP was around eight per cent in the 1980s (de Lassence et al., 2006). This decrease is believed to be due to improved equipment, techniques, and safer practices both for mechanical ventilation and procedure- related pneumothorax (Çelik et al., 2009).",{"type":15,"attrs":8147,"content":8148},{"textAlign":53},[8149],{"text":8150,"type":351},"The incidence of procedure-related pneumothorax has also been reduced by improved equipment (e.g., ultrasound), education, and training; these improvements have equally been noted in the non-ICU and pediatric settings (Duncan et al., 2009; Gordon et al., 2010; Havelock et al., 2010; Lenchus et al., 2010; Cavanna et al., 2010; Troianos et al., 2012).",{"type":15,"attrs":8152,"content":8153},{"textAlign":53},[8154],{"text":8155,"type":351},"Procedures associated with iatrogenic pneumothorax§",{"type":15,"attrs":8157,"content":8158},{"textAlign":53},[8159],{"text":8160,"type":351},"Any intervention in proximity to the abdomen, especially the thorax, can cause an iatrogenic pneumothorax. This is especially true when placing a subclavian central venous catheter without the use of ultrasound (i.e., \"blindly\") using landmarks. In landmark-based subclavian central venous catheter placement, per Kilbourne et al., six common technical errors include inadequate landmark identification, improper insertion position, insertion of the needle through periosteum, taking too shallow a trajectory with the needle, aiming the needle to cephalad, and failure to keep the needle in place for wire passage. Landmark technique also depends on the ability and experience of the medical professional performing the procedure, making iatrogenic pneumothorax more likely in a tertiary teaching hospital (Ojeda Rodriguez & Hipskind, 2021).",{"type":15,"attrs":8162,"content":8163},{"textAlign":53},[8164],{"text":8165,"type":351},"Other procedures associated with IP:",{"type":15,"attrs":8167,"content":8168},{"textAlign":53},[8169],{"text":8170,"type":351},"Dry needling (Health Quality Council of Alberta, 2014).",{"type":15,"attrs":8172,"content":8173},{"textAlign":53},[8174],{"text":8175,"type":351},"Airway-related: endotracheal tube insertion (intubation) or misplacement (neonates), inadequate clearance of trapped secretions, positive airway pressure devices (Carron et al., 2007; Chebel et al., 2010; Hegde & Prodhan, 2013; Milési et al., 2014).",{"type":15,"attrs":8177,"content":8178},{"textAlign":53},[8179],{"text":8180,"type":351},"Surgical: tracheostomy, thoracotomy, mediastinoscopy, cardiac surgery, insertion/revision/replacement/removal of cardiac pacemaker or cardioverter/defibrillator, breast augmentation, rarely: abdominal cavity operations.",{"type":15,"attrs":8182,"content":8183},{"textAlign":53},[8184],{"text":8185,"type":351},"Cardiopulmonary resuscitation (CPR).",{"type":15,"attrs":8187,"content":8188},{"textAlign":53},[8189],{"text":8190,"type":351},"Patient Risk Factors",{"type":15,"attrs":8192,"content":8193},{"textAlign":53},[8194],{"text":8195,"type":351},"Patient factors that increase the risk of pneumothorax in the setting of an intervention include:",{"type":438,"content":8197},[8198,8205,8212,8219,8226,8233,8240],{"type":441,"content":8199},[8200],{"type":15,"attrs":8201,"content":8202},{"textAlign":53},[8203],{"text":8204,"type":351},"Age.",{"type":441,"content":8206},[8207],{"type":15,"attrs":8208,"content":8209},{"textAlign":53},[8210],{"text":8211,"type":351},"Low body weight.*",{"type":441,"content":8213},[8214],{"type":15,"attrs":8215,"content":8216},{"textAlign":53},[8217],{"text":8218,"type":351},"Poor healing ability (chronic corticosteroid use, malnutrition).",{"type":441,"content":8220},[8221],{"type":15,"attrs":8222,"content":8223},{"textAlign":53},[8224],{"text":8225,"type":351},"Severity of acute illness.*",{"type":441,"content":8227},[8228],{"type":15,"attrs":8229,"content":8230},{"textAlign":53},[8231],{"text":8232,"type":351},"Acute or chronic pulmonary¹ or pleural¥ disease.",{"type":441,"content":8234},[8235],{"type":15,"attrs":8236,"content":8237},{"textAlign":53},[8238],{"text":8239,"type":351},"Agitation.",{"type":441,"content":8241},[8242],{"type":15,"attrs":8243,"content":8244},{"textAlign":53},[8245],{"text":8246,"type":351},"AIDS.*",{"type":15,"attrs":8248,"content":8249},{"textAlign":53},[8250],{"text":8251,"type":351},"§ Anzueto et al., 2004; de Lassence et al., 2006; Zhan et al., 2006; Çelik et al., 2009; Loiselle et al., 2013; Light & Lee, 2016, Ojeda Rodriguez & Hipskind, 2021",{"type":15,"attrs":8253,"content":8254},{"textAlign":53},[8255],{"text":8256,"type":351},"* Noted for ICU patients of all ages (de Lassence et al., 2006).",{"type":15,"attrs":8258,"content":8259},{"textAlign":53},[8260],{"text":8261,"type":351},"¹ Bronchopulmonary dysplasia, acute bronchiolitis, COPD, Adult or neonatal Respiratory Distress Syndrome, cardiogenic pulmonary edema, pneumonia, primary lung cancer (Anzueto et al., 2004).",{"type":15,"attrs":8263,"content":8264},{"textAlign":53},[8265],{"text":8266,"type":351},"¥ Malignant and parapneumonic pleural effusion, empyema (Nyman et al., 2008).",{"_uid":1359,"content":8268,"component":585},[8269],{"_uid":1362,"content":8270,"component":584},{"type":12,"content":8271},[8272,8276,8281,8285,8290,8295,8300,8305,8310],{"type":383,"attrs":8273,"content":8274},{"level":385,"textAlign":53},[8275],{"text":640,"type":351},{"type":15,"attrs":8277,"content":8278},{"textAlign":53},[8279],{"text":8280,"type":351},"A pneumothorax (a term for collapsed lung) occurs when air leaks into the space between a patient's lung and chest wall, creating pressure against the lung. Depending on how much air has leaked in, the patient's lung may only be partially collapsed, or it may collapse completely. The greater the pneumothorax, the more it will interfere with normal breathing and may even become life-threatening. The occurrence of a pneumothorax during hospitalization is likely to prolong hospital stay. After being treated for a collapsed lung with a tube, chances of having a recurrence is low, but possible. Patients should avoid scuba diving and flying in a plane for at least 72 hours.",{"type":383,"attrs":8282,"content":8283},{"level":413,"textAlign":53},[8284],{"text":5943,"type":351},{"type":383,"attrs":8286,"content":8287},{"level":2212,"textAlign":53},[8288],{"text":8289,"type":351},"A Case of Iatrogenic Pneumothorax",{"type":15,"attrs":8291,"content":8292},{"textAlign":53},[8293],{"text":8294,"type":351},"Ms. I. Ava Numeau, a 72-year old woman, underwent insertion of a central venous catheter via a subclavian approach in preparation for a right hemicolectomy. Now, she's restless and complains of shortness of breath and pleuritic chest pain. You take her vital signs: blood pressure 175/95, heart rate 115, respirations 28, and room air SpO2 89 per cent. On examination, she appears in mild-moderate respiratory distress. Over the left hemi thorax there is hyper-resonance to percussion and diminished air entry to auscultation.",{"type":15,"attrs":8296,"content":8297},{"textAlign":53},[8298],{"text":8299,"type":351},"Ms. Numeau was admitted the previous day for resection of a cecal adenocarcinoma, which caused significant weight loss from symptomatic recurrent intermittent incomplete bowel obstruction. Her past medical history includes hypertension controlled with medication and rheumatoid arthritis, for which she is on chronic corticosteroids. Her preadmission examination was unremarkable except for integumentary signs of chronic steroid use, early muscle wasting, and mild abdominal distension. After unsuccessful attempts at obtaining peripheral venous access and inability to insert an internal jugular venous catheter due to limited cervical spine and shoulder mobility, the physician inserted a central venous catheter via the left subclavian vein.",{"type":15,"attrs":8301,"content":8302},{"textAlign":53},[8303],{"text":8304,"type":351},"Ms. Numeau's history reveals several risk factors for pneumothorax and the bedside assessment is suggestive of an iatrogenic pneumothorax.",{"type":15,"attrs":8306,"content":8307},{"textAlign":53},[8308],{"text":8309,"type":351},"The event could have been prevented by the use of bedside ultrasound-guided insertion of the internal jugular vein, which may have required only minimal neck/shoulder positioning. In addition, a Trendelenburg positioning would have increased the size of the great thoracic veins thus facilitating central venous insertion/cannulation. Finally, a peripherally-inserted central catheter (PICC) could also have been entertained, depending on the skillset of the medical provider.",{"type":15,"attrs":8311,"content":8312},{"textAlign":53},[8313],{"text":8314,"type":351},"Ms. Numeau's nurse provided her with 100 per cent oxygen while monitoring her vital signs. A stat portable chest X-ray was done, confirming the diagnosis and the rapid response team prepared to insert a chest tube with a 14-gauge I.V. catheter at the bedside if the patient developed signs of tension pneumothorax. The patient received appropriate procedural sedation and analgesia. Within minutes of chest tube insertion, her vital signs normalized, and her chest pain and dyspnea resolved. Repeat chest X-ray confirmed proper positioning of the chest tube and resolution of the pneumothorax.",{"_uid":650,"items":8316,"title":765,"component":641,"description":8444},[8317],{"_uid":653,"title":654,"ctaLeft":8318,"ctaRight":8319,"component":603,"columnLeft":8320,"columnRight":8333},[],[],{"type":12,"content":8321},[8322],{"type":15,"attrs":8323,"content":8324},{"textAlign":53},[8325,8326,8332],{"text":2253,"type":351},{"text":2260,"type":351,"marks":8327},[8328],{"type":398,"attrs":8329},{"href":400,"uuid":401,"anchor":53,"custom":8330,"target":403,"linktype":404,"story":8331},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":672,"type":351},{"type":12,"content":8334},[8335,8340],{"type":15,"attrs":8336,"content":8337},{"textAlign":53},[8338],{"text":8339,"type":351},"If your review reveals that your cases of Pneumothorax are linked to specific processes or procedures, you may find these resources helpful:",{"type":438,"content":8341},[8342,8354,8361,8375,8389,8403,8417,8431],{"type":441,"content":8343},[8344],{"type":15,"attrs":8345,"content":8346},{"textAlign":53},[8347,8348],{"text":4771,"type":351},{"text":4773,"type":351,"marks":8349},[8350],{"type":398,"attrs":8351},{"href":8352,"uuid":53,"anchor":53,"custom":8353,"target":597,"linktype":598},"https://www.ahrq.gov/",{},{"type":441,"content":8355},[8356],{"type":15,"attrs":8357,"content":8358},{"textAlign":53},[8359],{"text":8360,"type":351},"Agency for Healthcare Research and Quality. Selected best practices and suggestions for improvement PSI 6: Iatrogenic pneumothorax. QI Toolkit Roadmap. Published 2014. Accessed March 2021. http://www.ahrq.gov/professionals/systems/hospital/qitoolkit/d4e-pneumothorax-bestpractices.pdf",{"type":441,"content":8362},[8363],{"type":15,"attrs":8364,"content":8365},{"textAlign":53},[8366,8368],{"text":8367,"type":351},"Journal of Hospital Medicine ",{"text":8369,"type":351,"marks":8370},"https://www.journalofhospitalmedicine.com",[8371],{"type":398,"attrs":8372},{"href":8373,"uuid":53,"anchor":53,"custom":8374,"target":597,"linktype":598},"https://shmpublications.onlinelibrary.wiley.com/journal/15535606",{},{"type":441,"content":8376},[8377],{"type":15,"attrs":8378,"content":8379},{"textAlign":53},[8380,8382],{"text":8381,"type":351},"Shieh L, Go M, Gessner D, Chen JH, Hopkins J, Maggio P. Improving and sustaining a reduction in iatrogenic pneumothorax through a multifaceted quality-improvement approach. Journal of hospital medicine. 2015;10(9):599-607. doi: ",{"text":8383,"type":351,"marks":8384},"10.1002/jhm.2388",[8385],{"type":398,"attrs":8386},{"href":8387,"uuid":53,"anchor":53,"custom":8388,"target":597,"linktype":598},"https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.2388",{},{"type":441,"content":8390},[8391],{"type":15,"attrs":8392,"content":8393},{"textAlign":53},[8394,8396],{"text":8395,"type":351},"Seminars in Respiratory and Critical Care Medicine ",{"text":8397,"type":351,"marks":8398},"https://www.thieme.in/seminars-in-respiratory-and-critical-care-medicine",[8399],{"type":398,"attrs":8400},{"href":8401,"uuid":53,"anchor":53,"custom":8402,"target":597,"linktype":598},"https://shop.thieme.in/",{},{"type":441,"content":8404},[8405],{"type":15,"attrs":8406,"content":8407},{"textAlign":53},[8408,8410],{"text":8409,"type":351},"Hallifax R, Janssen JP. Pneumothorax - time for new guidelines? Semin Respir Crit Care Med. 2019;40(3):314-322. doi:",{"text":8411,"type":351,"marks":8412},"10.1055/s-0039-1693499",[8413],{"type":398,"attrs":8414},{"href":8415,"uuid":53,"anchor":53,"custom":8416,"target":597,"linktype":598},"https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0039-1693499",{},{"type":441,"content":8418},[8419],{"type":15,"attrs":8420,"content":8421},{"textAlign":53},[8422,8424],{"text":8423,"type":351},"Thorax ",{"text":8425,"type":351,"marks":8426},"www.thorax.bmj.com",[8427],{"type":398,"attrs":8428},{"href":8429,"uuid":53,"anchor":53,"custom":8430,"target":597,"linktype":598},"https://thorax.bmj.com/",{},{"type":441,"content":8432},[8433],{"type":15,"attrs":8434,"content":8435},{"textAlign":53},[8436,8438],{"text":8437,"type":351},"Johnston SL (Ed.). BTS Pleural Disease Guideline 2010. Thorax. August 2010; 65(Suppl 2). ",{"text":8439,"type":351,"marks":8440},"https://thorax.bmj.com/content/65/Suppl_2",[8441],{"type":398,"attrs":8442},{"href":8439,"uuid":53,"anchor":53,"custom":8443,"target":597,"linktype":598},{},{"type":12,"content":8445},[8446,8454,8458],{"type":15,"attrs":8447,"content":8448},{"textAlign":53},[8449,8450,8453],{"text":2567,"type":351},{"text":8064,"type":351,"marks":8451},[8452],{"type":1417},{"text":2572,"type":351},{"type":15,"attrs":8455,"content":8456},{"textAlign":775},[8457],{"text":778,"type":351},{"type":780,"attrs":8459,"content":8460},{"order":782},[8461,8467,8473,8479],{"type":441,"content":8462},[8463],{"type":15,"attrs":8464,"content":8465},{"textAlign":53},[8466],{"text":790,"type":351},{"type":441,"content":8468},[8469],{"type":15,"attrs":8470,"content":8471},{"textAlign":53},[8472],{"text":797,"type":351},{"type":441,"content":8474},[8475],{"type":15,"attrs":8476,"content":8477},{"textAlign":53},[8478],{"text":804,"type":351},{"type":441,"content":8480},[8481],{"type":15,"attrs":8482,"content":8483},{"textAlign":53},[8484],{"text":811,"type":351},{"_uid":813,"items":8486,"title":858,"component":859,"description":8511},[8487,8493,8499,8505],{"_uid":835,"image":8488,"title":1629,"component":822,"description":8490},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":8489,"is_external_url":285},{},{"type":12,"content":8491},[8492],{"type":15},{"_uid":827,"image":8494,"title":830,"component":822,"description":8496},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":8495,"is_external_url":285},{},{"type":12,"content":8497},[8498],{"type":15},{"_uid":816,"image":8500,"title":821,"component":822,"description":8502},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":8501,"is_external_url":285},{},{"type":12,"content":8503},[8504],{"type":15},{"_uid":843,"image":8506,"title":838,"component":822,"description":8508},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":8507,"is_external_url":285},{},{"type":12,"content":8509},[8510],{"type":15},{"type":12,"content":8512},[8513],{"type":15,"attrs":8514,"content":8515},{"textAlign":53},[8516],{"text":1657,"type":351},{"_uid":868,"items":8518,"title":890,"component":641,"description":8659},[8519,8566,8616],{"_uid":871,"title":872,"ctaLeft":8520,"ctaRight":8521,"component":603,"columnLeft":8522,"columnRight":8526},[],[],{"type":12,"content":8523},[8524],{"type":15,"attrs":8525},{"textAlign":53},{"type":12,"content":8527},[8528,8535,8544,8552,8557,8561],{"type":15,"attrs":8529,"content":8530},{"textAlign":53},[8531,8534],{"text":2708,"type":351,"marks":8532},[8533],{"type":677},{"text":2712,"type":351},{"type":15,"attrs":8536,"content":8537},{"textAlign":53},[8538,8542],{"text":8539,"type":351,"marks":8540},"J95.80",[8541],{"type":677},{"text":8543,"type":351},": Identified as diagnosis type (2) AND Y60–Y84 in the same diagnosis cluster",{"type":15,"attrs":8545,"content":8546},{"textAlign":53},[8547,8551],{"text":8548,"type":351,"marks":8549},"S27.0–, S27.2–",[8550],{"type":677},{"text":6225,"type":351},{"type":15,"attrs":8553,"content":8554},{"textAlign":53},[8555],{"text":8556,"type":351},"Identified as diagnosis type (3) AND T80–T88 as diagnosis type (2) AND Y60–Y84 in the same diagnosis cluster",{"type":15,"attrs":8558,"content":8559},{"textAlign":53},[8560],{"text":2731,"type":351},{"type":15,"attrs":8562,"content":8563},{"textAlign":53},[8564],{"text":8565,"type":351},"Identified as diagnosis type (2) AND Y60–Y84 in the same diagnosis cluster",{"_uid":1697,"title":1698,"ctaLeft":8567,"ctaRight":8568,"component":603,"columnLeft":8569,"columnRight":8573},[],[],{"type":12,"content":8570},[8571],{"type":15,"attrs":8572},{"textAlign":53},{"type":12,"content":8574},[8575,8582,8590,8598,8607],{"type":15,"attrs":8576,"content":8577},{"textAlign":53},[8578,8581],{"text":2708,"type":351,"marks":8579},[8580],{"type":677},{"text":2807,"type":351},{"type":15,"attrs":8583,"content":8584},{"textAlign":53},[8585,8588],{"text":5360,"type":351,"marks":8586},[8587],{"type":677},{"text":8589,"type":351},": Code descriptions",{"type":15,"attrs":8591,"content":8592},{"textAlign":53},[8593,8596],{"text":8539,"type":351,"marks":8594},[8595],{"type":677},{"text":8597,"type":351},": Post-procedural pneumothorax",{"type":15,"attrs":8599,"content":8600},{"textAlign":53},[8601,8605],{"text":8602,"type":351,"marks":8603},"S27.0–",[8604],{"type":677},{"text":8606,"type":351},": Traumatic pneumothorax",{"type":15,"attrs":8608,"content":8609},{"textAlign":53},[8610,8614],{"text":8611,"type":351,"marks":8612},"S27.2–",[8613],{"type":677},{"text":8615,"type":351},": Traumatic hemopneumothorax",{"_uid":1743,"title":1744,"ctaLeft":8617,"ctaRight":8618,"component":603,"columnLeft":8619,"columnRight":8623},[],[],{"type":12,"content":8620},[8621],{"type":15,"attrs":8622},{"textAlign":53},{"type":12,"content":8624},[8625,8630,8645],{"type":15,"attrs":8626,"content":8627},{"textAlign":53},[8628],{"text":8629,"type":351},"Additional Codes: Code descriptions",{"type":15,"attrs":8631,"content":8632},{"textAlign":53},[8633,8637,8639],{"text":8634,"type":351,"marks":8635},"T80–T88",[8636],{"type":677},{"text":8638,"type":351},": Complications of surgical and medical care not elsewhere classified. Refer to Appendix A of the ",{"text":8640,"type":351,"marks":8641},"Hospital Harm Indicator General Methodology Notes.",[8642],{"type":398,"attrs":8643},{"href":3092,"uuid":53,"anchor":53,"custom":8644,"target":597,"linktype":598},{},{"type":15,"attrs":8646,"content":8647},{"textAlign":53},[8648,8651,8653,8658],{"text":3083,"type":351,"marks":8649},[8650],{"type":677},{"text":8652,"type":351},": Complications of medical and surgical care. Refer to Appendix A of the ",{"text":1778,"type":351,"marks":8654},[8655],{"type":398,"attrs":8656},{"href":3092,"uuid":53,"anchor":53,"custom":8657,"target":597,"linktype":598},{},{"text":672,"type":351},{"type":12,"content":8660},[8661,8669],{"type":15,"attrs":8662,"content":8663},{"textAlign":53},[8664,8665],{"text":1790,"type":351},{"text":8666,"type":351,"marks":8667},"D22: Pneumothorax",[8668],{"type":677},{"type":15,"attrs":8670,"content":8671},{"textAlign":53},[8672,8675],{"text":5405,"type":351,"marks":8673},[8674],{"type":677},{"text":8676,"type":351},": Pneumothorax associated with a medical or surgical procedure.",{"_uid":8678,"content":8679,"component":585},"33246a68-1baa-4d17-800e-30dcd6328ce4",[8680],{"_uid":8681,"content":8682,"component":584},"f4869ee7-ede2-4ec4-a888-d0e33ce09360",{"type":12,"content":8683},[8684,8688],{"type":383,"attrs":8685,"content":8686},{"level":385,"textAlign":53},[8687],{"text":957,"type":351},{"type":15,"attrs":8689,"content":8690},{"textAlign":53},[8691],{"text":8692,"type":351},"In an academic tertiary care hospital, an interprofessional team including physicians, nurses, and administrative leaders improved and sustained a reduction in iatrogenic pneumothoraces. This was done by implementing clinical documentation standards, cognitive aids, simulation training, purchase/employment of ultrasound equipment, and feedback to clinical services. The role of interprofessional communication and care coordination between health professionals cannot be understated when considering patient outcomes (Shieh et al., 2015). ",{"_uid":963,"items":8694,"title":1064,"component":641,"description":8906},[8695],{"_uid":966,"title":967,"ctaLeft":8696,"ctaRight":8697,"component":603,"columnLeft":8698,"columnRight":8702},[],[],{"type":12,"content":8699},[8700],{"type":15,"attrs":8701},{"textAlign":53},{"type":12,"content":8703},[8704,8709,8714,8719,8724,8735,8740,8745,8750,8755,8760,8765,8770,8775,8780,8785,8790,8795,8800,8811,8816,8821,8826,8838,8843,8848,8853,8865,8877,8882,8894],{"type":15,"attrs":8705,"content":8706},{"textAlign":53},[8707],{"text":8708,"type":351},"Agency for Healthcare Research and Quality. Quality indicators comparison of observed rates of all indicators between v2019 and v2020. AHRQ. Published 2020. https://www.qualityindicators.ahrq.gov/Downloads/Software/V2020/AHRQ_QI_Rate_Comparison_v2019_v2020.pdf",{"type":15,"attrs":8710,"content":8711},{"textAlign":53},[8712],{"text":8713,"type":351},"Amato MBP, Barbas CSV, Medeiros DM, et al. Effect of a protective-ventilation strategy on mortality in the acute respiratory distress syndrome. N Engl J Med. 1998;338(6):347-354. doi:10.1056/NEJM199802053380602",{"type":15,"attrs":8715,"content":8716},{"textAlign":53},[8717],{"text":8718,"type":351},"Anzueto A, Frutos–Vivar F, Esteban A, et al. Incidence, risk factors and outcome of barotrauma in mechanically ventilated patients. Intensive Care Medicine. 2004;30(4):612-619. doi:10.1007/s00134-004-2187-7",{"type":15,"attrs":8720,"content":8721},{"textAlign":53},[8722],{"text":8723,"type":351},"Canadian Institute for Health Information. Appendix A. In: Hospital Harm Indicator: General Methodology Notes. Canadian Institute for Health Information; 2019. https://indicatorlibrary.cihi.ca/display/HSPIL/Hospital+Harm?preview=/10453027/15564910/Hospital%20Harm%20Indicator%20General%20Methodology%20Notes.pdf",{"type":15,"attrs":8725,"content":8726},{"textAlign":53},[8727,8729],{"text":8728,"type":351},"Canadian Institute for Health Information. Hospital Harm Project Data Tables: Hospital Harm Results, 2014-2015 to 2019-2020. Published online 2020. ",{"text":8730,"type":351,"marks":8731},"https://www.cihi.ca/en/hospital-harm-project",[8732],{"type":398,"attrs":8733},{"href":8730,"uuid":53,"anchor":53,"custom":8734,"target":597,"linktype":598},{},{"type":15,"attrs":8736,"content":8737},{"textAlign":53},[8738],{"text":8739,"type":351},"Canadian Patient Safety Institute (CPSI). Global Patient Safety Alerts. Published n.d. 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Thorac Cardiovasc Surg. 2009;57(05):286-290. doi:10.1055/s-0029-1185365",{"type":15,"attrs":8756,"content":8757},{"textAlign":53},[8758],{"text":8759,"type":351},"Chan B, Cochrane D, Canadian Institute for Health Information, Canadian Patient Safety Institute. Appendix B. In: Measuring patient harm in Canadian hospitals. Canadian Institute for Health Information; 2016. https://secure.cihi.ca/free_products/cihi_cpsi_hospital_harm_en.pdf",{"type":15,"attrs":8761,"content":8762},{"textAlign":53},[8763],{"text":8764,"type":351},"Chebel NA, Ziade D, Achkouty R. Bilateral pneumothorax and pneumomediastinum after treatment with continuous positive airway pressure after orthognathic surgery. British Journal of Oral and Maxillofacial Surgery. 2010;48(4):e14-e15. doi:10.1016/j.bjoms.2009.12.005",{"type":15,"attrs":8766,"content":8767},{"textAlign":53},[8768],{"text":8769,"type":351},"Chen K-Y, Jerng J-S, Liao W-Y, et al. Pneumothorax in the ICU: patient outcomes and prognostic factors. Chest. 2002;122(2):678-683. doi:10.1378/chest.122.2.678",{"type":15,"attrs":8771,"content":8772},{"textAlign":53},[8773],{"text":8774,"type":351},"de Lassence A, Timsit J-F, Tafflet M, et al. Pneumothorax in the intensive care unit: incidence, risk factors, and outcome. Anesthesiology. 2006;104(1):5-13. doi:10.1097/00000542-200601000-00003",{"type":15,"attrs":8776,"content":8777},{"textAlign":53},[8778],{"text":8779,"type":351},"Duncan DR, Morgenthaler TI, Ryu JH, Daniels CE. Reducing iatrogenic risk in thoracentesis: establishing best practice via experiential training in a zero-risk environment. CHEST. 2009;135(5):1315-1320. doi:10.1378/chest.08-1227",{"type":15,"attrs":8781,"content":8782},{"textAlign":53},[8783],{"text":8784,"type":351},"Esteban A, Anzueto A, Frutos F, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study. 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Thorax. 2010;65(Suppl 2):i61. doi:10.1136/thx.2010.137026",{"type":15,"attrs":8801,"content":8802},{"textAlign":53},[8803,8805],{"text":8804,"type":351},"Health Quality Council of Alberta (HQCA). The safe practice of dry needling in Alberta: summary report. HQCA; 2014. ",{"text":8806,"type":351,"marks":8807},"https://d10k7k7mywg42z.cloudfront.net/assets/5445339bd4c96163370154ed/FINAL___Dry_Needling_Report_10202014.pdf",[8808],{"type":398,"attrs":8809},{"href":8806,"uuid":53,"anchor":53,"custom":8810,"target":597,"linktype":598},{},{"type":15,"attrs":8812,"content":8813},{"textAlign":53},[8814],{"text":8815,"type":351},"Hegde S, Prodhan P. Serious air leak syndrome complicating high-flow nasal cannula therapy: a report of 3 cases. Pediatrics. 2013;131(3):e939. doi:10.1542/peds.2011-3767",{"type":15,"attrs":8817,"content":8818},{"textAlign":53},[8819],{"text":8820,"type":351},"Institute for Healthcare Improvement. How-to guide: prevent harm from high-alert medications. 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Annals of Intensive Care. 2014;4(1):29. doi:10.1186/s13613-014-0029-5",{"type":15,"attrs":8849,"content":8850},{"textAlign":53},[8851],{"text":8852,"type":351},"Nyman AG, Sonnappa S, Prendiville AT, Jaffe A. Ventilation induced pneumothorax following resolved empyema. Pediatric Pulmonology. 2008;43(1):99-101. doi:10.1002/ppul.20684",{"type":15,"attrs":8854,"content":8855},{"textAlign":53},[8856,8858],{"text":8857,"type":351},"Ojeda Rodriguez JA, Hipskind JE. Iatrogenic Pneumothorax. In: StatPearls. StatPearls Publishing; 2021. ",{"text":8859,"type":351,"marks":8860},"http://www.ncbi.nlm.nih.gov/books/NBK526057/",[8861],{"type":398,"attrs":8862},{"href":8863,"uuid":53,"anchor":53,"custom":8864,"target":597,"linktype":598},"https://www.ncbi.nlm.nih.gov/books/NBK526057/",{},{"type":15,"attrs":8866,"content":8867},{"textAlign":53},[8868,8870],{"text":8869,"type":351},"Schnapp LM, Chin DP, Szaflarski N, Matthay MA. Frequency and importance of barotrauma in 100 patients with acute lung injury. Critical Care Medicine. 1995;23(2). ",{"text":8871,"type":351,"marks":8872},"https://journals.lww.com/ccmjournal/Fulltext/1995/02000/Frequency_and_importance_of_barotrauma_in_100.12.aspx",[8873],{"type":398,"attrs":8874},{"href":8875,"uuid":53,"anchor":53,"custom":8876,"target":597,"linktype":598},"https://journals.lww.com/ccmjournal/abstract/1995/02000/frequency_and_importance_of_barotrauma_in_100.12.aspx",{},{"type":15,"attrs":8878,"content":8879},{"textAlign":53},[8880],{"text":8881,"type":351},"Shieh L, Go M, Gessner D, Chen JH, Hopkins J, Maggio P. Improving and sustaining a reduction in iatrogenic pneumothorax through a multifaceted quality-improvement approach. Journal of hospital medicine. 2015;10(9):599-607. doi:10.1002/jhm.2388",{"type":15,"attrs":8883,"content":8884},{"textAlign":53},[8885,8887],{"text":8886,"type":351},"Troianos CA, Hartman GS, Glas KE, et al. Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesthesia & Analgesia. 2012;114(1). ",{"text":8888,"type":351,"marks":8889},"https://journals.lww.com/anesthesia-analgesia/Fulltext/2012/01000/Guidelines_for_Performing_Ultrasound_Guided.7.aspx",[8890],{"type":398,"attrs":8891},{"href":8892,"uuid":53,"anchor":53,"custom":8893,"target":597,"linktype":598},"https://journals.lww.com/anesthesia-analgesia/citation/2012/01000/guidelines_for_performing_ultrasound_guided.7.aspx",{},{"type":15,"attrs":8895,"content":8896},{"textAlign":53},[8897,8899],{"text":8898,"type":351},"Zhan C, Smith M, Stryer D. Accidental iatrogenic pneumothorax in hospitalized patients. Medical Care. 2006;44(2).",{"text":8900,"type":351,"marks":8901}," https://journals.lww.com/lww-medicalcare/Fulltext/2006/02000/Accidental_Iatrogenic_Pneumothorax_in_Hospitalized.12.aspx",[8902],{"type":398,"attrs":8903},{"href":8904,"uuid":53,"anchor":53,"custom":8905,"target":597,"linktype":598},"https://journals.lww.com/lww-medicalcare/abstract/2006/02000/accidental_iatrogenic_pneumothorax_in_hospitalized.12.aspx",{},{"type":12,"content":8907},[8908],{"type":15},{"id":16,"_uid":8910,"items":8911,"component":1097},"f4aad670-68f6-4091-9f99-9236a96bbe82",[8912],{"_uid":8913,"link":8914,"image":8919,"title":1088,"component":1089,"description":8921},"94850e62-2fcb-459e-8e9e-1dc125a14369",[8915],{"_uid":8916,"link":8917,"label":1082,"component":1083},"5294d4e8-89ba-4b02-92b5-0ccca9d03d97",{"id":1077,"url":16,"linktype":404,"fieldtype":599,"cached_url":1078,"story":8918},{"name":1080,"id":1081,"uuid":1077,"slug":9,"url":1078,"full_slug":1078,"_stopResolving":291},{"id":1085,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":1086,"copyright":16,"fieldtype":283,"meta_data":8920,"is_external_url":285},{},{"type":12,"content":8922},[8923],{"type":15,"attrs":8924,"content":8925},{"textAlign":53},[8926],{"text":1096,"type":351},[129,150,136,122,143,115,157],[185,192,200],"pneumothorax","resources/pneumothorax",-18680,[],"d5debcff-2c3e-4069-aa01-6d070235cd7d","2025-12-10T14:49:25.180Z",[],[8937],{"path":8938,"name":8064,"lang":305,"published":291},"ressources/pneumothorax",{"name":8940,"created_at":8941,"published_at":8942,"updated_at":8943,"id":8944,"uuid":8945,"content":8946,"slug":11589,"full_slug":11590,"sort_by_date":53,"position":11591,"tag_list":11592,"is_startpage":285,"parent_id":1105,"meta_data":53,"group_id":11593,"first_published_at":11594,"release_id":53,"lang":299,"path":53,"alternates":11595,"default_full_slug":11590,"translated_slugs":11596},"Obstetric Trauma","2025-12-10T20:45:03.052Z","2026-03-10T16:34:58.650Z","2026-03-10T16:34:58.761Z",121691762967378,"2de4066e-c3ce-45c8-961f-c8ec5e2b2431",{"new":285,"seo":8947,"_uid":331,"hero":8948,"type":174,"topics":8969,"Noindex":285,"content":8970,"audience":11587,"duration":16,"regional":11588,"component":1100},{"_uid":328,"title":8940,"plugin":329,"og_image":16,"og_title":16,"description":2038,"twitter_image":16,"twitter_title":16,"og_description":16,"twitter_description":16},[8949],{"_uid":334,"image":8950,"title":8952,"format":8953,"component":343,"description":8956,"key_learning":8963,"prerequisite":8966},{"id":336,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":337,"copyright":16,"fieldtype":283,"meta_data":8951,"is_external_url":285},{"alt":16,"title":16,"source":16,"copyright":16},"Hospital Harm: Obstetric Trauma",{"type":12,"content":8954},[8955],{"type":15},{"type":12,"content":8957},[8958],{"type":15,"attrs":8959,"content":8960},{"textAlign":53},[8961],{"text":8962,"type":351},"Lacerations are common after vaginal birth. Trauma can occur on the cervix, vagina, and vulva, including the labial, periclitoral, and periurethral regions, and the perineum (American College of Obstetricians and Gynecologists (ACOG), 2018). A woman's safety during childbirth can be assessed by looking at potentially avoidable tearing of the perineum (Organization for Economic Co-operation and Development (OECD), 2019) and other obstetrical injuries to the pelvic organs during vaginal deliveries. While it is not possible to prevent these types of tears in all cases, they can be reduced by appropriate labour management and high-quality obstetric care (OECD, 2019).",{"type":12,"content":8964},[8965],{"type":15},{"type":12,"content":8967},[8968],{"type":15},[76,8],[8971,8982,9070,9121,9433,9465,11099,11260,11569],{"_uid":361,"link":8972,"image":8973,"title":365,"component":366,"media_type":367,"description":8975},[],{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":283,"meta_data":8974},{},{"type":12,"content":8976},[8977],{"type":15,"attrs":8978,"content":8979},{"textAlign":53},[8980],{"text":8981,"type":351},"Reduce the incidence of obstetric trauma captured in this clinical group.",{"_uid":376,"content":8983,"component":585},[8984],{"_uid":379,"content":8985,"component":584},{"type":12,"content":8986},[8987,8991,9002,9007,9012,9017],{"type":383,"attrs":8988,"content":8989},{"level":385,"textAlign":53},[8990],{"text":388,"type":351},{"type":15,"attrs":8992,"content":8993},{"textAlign":53},[8994,8995,9001],{"text":393,"type":351},{"text":395,"type":351,"marks":8996},[8997],{"type":398,"attrs":8998},{"href":400,"uuid":401,"anchor":53,"custom":8999,"target":403,"linktype":404,"story":9000},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":410,"type":351},{"type":383,"attrs":9003,"content":9004},{"level":413,"textAlign":53},[9005],{"text":9006,"type":351},"Obstetric anal sphincter injuries (also known as Obstetric Anal Sphincter Injury - OASI)",{"type":15,"attrs":9008,"content":9009},{"textAlign":53},[9010],{"text":9011,"type":351},"Perineal trauma occurs either spontaneously with vaginal delivery or secondarily as an extension to an episiotomy. Severe perineal trauma can involve damage to the anal sphincters and anal mucosa. Obstetric anal sphincter injuries (OASIS) refers to third- and fourth-degree perineal tears. Third degree tears involve a partial or complete disruption of the anal sphincter complex which includes the external anal sphincter and the internal anal sphincter. Fourth degree tears involve disruption of the anal mucosa in addition to division of the anal sphincter complex (Aasheim et al., 2017; Harvey & Pierce, 2015). The table below lists the classification of OASIS from first to fourth degree.",{"type":15,"attrs":9013,"content":9014},{"textAlign":53},[9015],{"text":9016,"type":351},"The list below lists the classification of OASIS from  first to fourth degree:",{"type":438,"content":9018},[9019,9026,9033,9063],{"type":441,"content":9020},[9021],{"type":15,"attrs":9022,"content":9023},{"textAlign":53},[9024],{"text":9025,"type":351},"First degree: Injury to perineal skin only",{"type":441,"content":9027},[9028],{"type":15,"attrs":9029,"content":9030},{"textAlign":53},[9031],{"text":9032,"type":351},"Second degree: Injury to perineum involving perineal muscles but not involving the anal sphincter",{"type":441,"content":9034},[9035,9040],{"type":15,"attrs":9036,"content":9037},{"textAlign":53},[9038],{"text":9039,"type":351},"Third degree: Injury to perineum involving the anal sphincter complex:",{"type":438,"content":9041},[9042,9049,9056],{"type":441,"content":9043},[9044],{"type":15,"attrs":9045,"content":9046},{"textAlign":53},[9047],{"text":9048,"type":351},"3a: Less than 50% of external anal sphincter (EAS) thickness torn",{"type":441,"content":9050},[9051],{"type":15,"attrs":9052,"content":9053},{"textAlign":53},[9054],{"text":9055,"type":351},"3b: More than 50% of EAS thickness torn",{"type":441,"content":9057},[9058],{"type":15,"attrs":9059,"content":9060},{"textAlign":53},[9061],{"text":9062,"type":351},"3c: Both EAS and internal anal sphincter (IAS) torn",{"type":441,"content":9064},[9065],{"type":15,"attrs":9066,"content":9067},{"textAlign":53},[9068],{"text":9069,"type":351},"Fourth degree: Injury to perineum involving the anal sphincter complex (EAS and IAS) and anal epithelium",{"_uid":1359,"content":9071,"component":585},[9072,9100,9107,9114],{"_uid":1362,"content":9073,"component":584},{"type":12,"content":9074},[9075,9079,9084,9089,9095],{"type":383,"attrs":9076,"content":9077},{"level":385,"textAlign":53},[9078],{"text":640,"type":351},{"type":15,"attrs":9080,"content":9081},{"textAlign":53},[9082],{"text":9083,"type":351},"In Canada, there are approximately to 380,000 births each year (Statistics Canada, n.d.). Although many births may appear to be 'normal' and uneventful, data portray a different scenario. According to data from the OECD, of the 23 reporting countries in 2017, Canada had the highest reported rate of obstetric trauma for both vaginal delivers with and without instruments (OECD, 2019).",{"type":15,"attrs":9085,"content":9086},{"textAlign":53},[9087],{"text":9088,"type":351},"Obstetric trauma is among the most common adverse events in Canada. Obstetric trauma, including third degree and greater lacerations which may result in longer lengths of stay for mothers, as well as chronic complications such as fecal incontinence, dyspareunia, perineal pain and other pelvic floor disorders (CIHI, n.d.). The immediate and long term psychological and physical impact of these complications on the mother and family are difficult to calculate. Many of the adverse events that occur are the result of system failures, rather than individual failures. It is now known that by creating a more reliable system of care we will be able to prevent, mitigate, and identify opportunities to prevent harm (Institute for Healthcare Improvement (IHI), 2012). ",{"type":383,"attrs":9090,"content":9091},{"level":413,"textAlign":775},[9092],{"text":5943,"type":351,"marks":9093},[9094],{"type":677},{"type":15,"attrs":9096,"content":9097},{"textAlign":775},[9098],{"text":9099,"type":351},"Here are videos of three women who have anonymously spoken out about their experience of suffering from the effects of an OASIS (RCOG, n.d.).",{"_uid":9101,"file":9102,"link":9104,"label":9106,"linkType":398,"component":4203,"linkLabel":4667},"c04546fc-f022-44e8-8d01-c91a12299a1c",{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":283,"meta_data":9103},{},{"id":16,"url":9105,"target":597,"linktype":598,"fieldtype":599,"cached_url":9105},"https://vimeo.com/294530426/d004dd236c","Tia's story",{"_uid":9108,"file":9109,"link":9111,"label":9113,"linkType":398,"component":4203,"linkLabel":4667},"c07fd542-fe21-4b52-bee0-37cf3c94a720",{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":283,"meta_data":9110},{},{"id":16,"url":9112,"target":597,"linktype":598,"fieldtype":599,"cached_url":9112},"https://vimeo.com/294530104/243c60ea51","Sarah's story",{"_uid":9115,"file":9116,"link":9118,"label":9120,"linkType":398,"component":4203,"linkLabel":4667},"6c5392a1-65bd-4c18-bc78-9c106f2dd114",{"id":53,"alt":53,"name":16,"focus":53,"title":53,"source":53,"filename":16,"copyright":53,"fieldtype":283,"meta_data":9117},{},{"id":16,"url":9119,"target":597,"linktype":598,"fieldtype":599,"cached_url":9119},"https://vimeo.com/294529908/bbcde5af60","Lisa's story",{"_uid":650,"items":9122,"title":765,"component":641,"description":9395},[9123],{"_uid":653,"title":654,"ctaLeft":9124,"ctaRight":9125,"component":603,"columnLeft":9126,"columnRight":9139},[],[],{"type":12,"content":9127},[9128],{"type":15,"attrs":9129,"content":9130},{"textAlign":53},[9131,9132,9138],{"text":2253,"type":351},{"text":2260,"type":351,"marks":9133},[9134],{"type":398,"attrs":9135},{"href":400,"uuid":401,"anchor":53,"custom":9136,"target":403,"linktype":404,"story":9137},{},{"name":395,"id":406,"uuid":401,"slug":407,"url":408,"full_slug":408,"_stopResolving":291},{"text":672,"type":351},{"type":12,"content":9140},[9141,9146],{"type":15,"attrs":9142,"content":9143},{"textAlign":53},[9144],{"text":9145,"type":351},"If your review reveals that your cases of OB Trauma are related linked to specific processes or procedures, you may find these resources helpful:",{"type":438,"content":9147},[9148,9187,9201,9217,9230,9243,9256,9271,9284,9297,9313,9326,9333,9340,9355,9362,9369,9382],{"type":441,"content":9149},[9150,9164],{"type":15,"attrs":9151,"content":9152},{"textAlign":53},[9153,9155,9158],{"text":9154,"type":351},"American College of Obstetricians and Gynecologists (ACOG).",{"text":674,"type":351,"marks":9156},[9157],{"type":677},{"text":9159,"type":351,"marks":9160},"https://www.acog.org/",[9161,9163],{"type":398,"attrs":9162},{"href":9159,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"type":438,"content":9165},[9166,9173,9180],{"type":441,"content":9167},[9168],{"type":15,"attrs":9169,"content":9170},{"textAlign":53},[9171],{"text":9172,"type":351},"Prevention and Management of Obstetric Lacerations at Vaginal Delivery. ACOG Practice Bulletin, Clinical Management Guidelines for Obstetrician–Gynecologists. Number 198, September 2018.",{"type":441,"content":9174},[9175],{"type":15,"attrs":9176,"content":9177},{"textAlign":53},[9178],{"text":9179,"type":351},"Operative Vaginal Delivery. ACOG Practice Bulletin, Clinical Management Guidelines for Obstetrician–Gynecologists. Number 154, November 2015.",{"type":441,"content":9181},[9182],{"type":15,"attrs":9183,"content":9184},{"textAlign":53},[9185],{"text":9186,"type":351},"Vaginal Birth After Cesarean Delivery. ACOG Practice Bulletin, Clinical Management Guidelines for Obstetrician–Gynecologists. Number 2015, February 2019.  ",{"type":441,"content":9188},[9189],{"type":15,"attrs":9190,"content":9191},{"textAlign":53},[9192,9194],{"text":9193,"type":351},"Association of Women's Health, Obstetric and Neonatal Nurses. ",{"text":9195,"type":351,"marks":9196},"www.awhonn.org",[9197,9200],{"type":398,"attrs":9198},{"href":9199,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},"http://www.awhonn.org/",{"type":2267},{"type":441,"content":9202},[9203],{"type":15,"attrs":9204,"content":9205},{"textAlign":53},[9206,9208,9211],{"text":9207,"type":351},"Association of Ontario Midwives.",{"text":674,"type":351,"marks":9209},[9210],{"type":677},{"text":9212,"type":351,"marks":9213},"https://www.ontariomidwives.ca/",[9214,9216],{"type":398,"attrs":9215},{"href":9212,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"type":441,"content":9218},[9219],{"type":15,"attrs":9220,"content":9221},{"textAlign":53},[9222,9224],{"text":9223,"type":351},"Vaginal birth after Previous Low-Segment Caesarean Section, Clinical Practice Guideline, 14. September 2011. ",{"text":9225,"type":351,"marks":9226},"https://www.ontariomidwives.ca/sites/default/files/CPG%20full%20guidelines/CPG-Vaginal-birth-after-caesarean-section-PUB.pdf",[9227,9229],{"type":398,"attrs":9228},{"href":9225,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"type":441,"content":9231},[9232],{"type":15,"attrs":9233,"content":9234},{"textAlign":53},[9235,9237],{"text":9236,"type":351},"Ontario Health. ",{"text":9238,"type":351,"marks":9239},"https://www.hqontario.ca/",[9240,9242],{"type":398,"attrs":9241},{"href":9238,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"type":441,"content":9244},[9245],{"type":15,"attrs":9246,"content":9247},{"textAlign":53},[9248,9250],{"text":9249,"type":351},"Vaginal Birth After Caesarean: (VBAC)-Quality Standard-",{"text":9251,"type":351,"marks":9252},"https://www.hqontario.ca/Evidence-to-Improve-Care/Quality-Standards/View-all-Quality-Standards/Vaginal-Birth-After-Caesarean-VBAC",[9253,9255],{"type":398,"attrs":9254},{"href":9251,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"type":441,"content":9257},[9258],{"type":15,"attrs":9259,"content":9260},{"textAlign":53},[9261,9263,9266],{"text":9262,"type":351},"National Institute for Health and Care Excellence (NICE).",{"text":674,"type":351,"marks":9264},[9265],{"type":677},{"text":1544,"type":351,"marks":9267},[9268,9270],{"type":398,"attrs":9269},{"href":1544,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"type":441,"content":9272},[9273],{"type":15,"attrs":9274,"content":9275},{"textAlign":53},[9276,9278],{"text":9277,"type":351},"Intrapartum care for healthy women and babies. Clinical guideline 190. Published date: December 2014, Last updated: February 2017. ",{"text":9279,"type":351,"marks":9280},"https://www.nice.org.uk/guidance/cg190",[9281,9283],{"type":398,"attrs":9282},{"href":9279,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"type":441,"content":9285},[9286],{"type":15,"attrs":9287,"content":9288},{"textAlign":53},[9289,9291],{"text":9290,"type":351},"Caesarean section. Clinical guideline 132. Published date:  November 2011 Last updated: September 2019. ",{"text":9292,"type":351,"marks":9293},"https://www.nice.org.uk/guidance/cg132",[9294,9296],{"type":398,"attrs":9295},{"href":9292,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"type":441,"content":9298},[9299],{"type":15,"attrs":9300,"content":9301},{"textAlign":53},[9302,9304,9307],{"text":9303,"type":351},"Royal College of Obstetricians and Gynaecologists (RCOG).",{"text":674,"type":351,"marks":9305},[9306],{"type":677},{"text":9308,"type":351,"marks":9309},"https://www.rcog.org.uk/",[9310,9312],{"type":398,"attrs":9311},{"href":9308,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"type":441,"content":9314},[9315],{"type":15,"attrs":9316,"content":9317},{"textAlign":53},[9318,9320],{"text":9319,"type":351},"The OASI Care Bundle Project- ",{"text":9321,"type":351,"marks":9322},"https://www.rcog.org.uk/en/guidelines-research-services/audit-quality-improvement/oasi-care-bundle/",[9323,9325],{"type":398,"attrs":9324},{"href":9321,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"type":441,"content":9327},[9328],{"type":15,"attrs":9329,"content":9330},{"textAlign":53},[9331],{"text":9332,"type":351},"The Management of Third- and Fourth-Degree Perineal Tears- Green-top Guideline No. 29, June 2015",{"type":441,"content":9334},[9335],{"type":15,"attrs":9336,"content":9337},{"textAlign":53},[9338],{"text":9339,"type":351},"Birth After Previous Caesarean Birth-Green-top Guideline No. 45, October 2015",{"type":441,"content":9341},[9342],{"type":15,"attrs":9343,"content":9344},{"textAlign":53},[9345,9347,9353],{"text":9346,"type":351},"Society of Obstetricians and Gynaecologists of Canada (SOGC). ",{"text":9348,"type":351,"marks":9349},"https://sogc.org/",[9350,9352],{"type":398,"attrs":9351},{"href":9348,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"text":9354,"type":351},"Obstetrical Anal Sphincter Injuries (OASIS): Prevention, Recognition, and Repair.  SOGC Clinical Practice Guideline. No. 330, December 2015.",{"type":441,"content":9356},[9357],{"type":15,"attrs":9358,"content":9359},{"textAlign":53},[9360],{"text":9361,"type":351},"Assisted Vaginal Birth. SOGC Clinical Practice Guideline. No. 381, June 2019.",{"type":441,"content":9363},[9364],{"type":15,"attrs":9365,"content":9366},{"textAlign":53},[9367],{"text":9368,"type":351},"Trial of Labour After Caesarean. SOGC Clinical Practice Guideline. No. 382, July 2019.",{"type":441,"content":9370},[9371],{"type":15,"attrs":9372,"content":9373},{"textAlign":53},[9374,9376],{"text":9375,"type":351},"World Health Organization (WHO). ",{"text":9377,"type":351,"marks":9378},"https://www.who.int/",[9379,9381],{"type":398,"attrs":9380},{"href":9377,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"type":441,"content":9383},[9384],{"type":15,"attrs":9385,"content":9386},{"textAlign":53},[9387,9389],{"text":9388,"type":351},"WHO Safe Childbirth Checklist. ",{"text":9390,"type":351,"marks":9391},"https://www.who.int/patientsafety/implementation/checklists/childbirth/en/",[9392,9394],{"type":398,"attrs":9393},{"href":9390,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},{"type":2267},{"type":12,"content":9396},[9397,9402,9406],{"type":15,"attrs":9398,"content":9399},{"textAlign":53},[9400],{"text":9401,"type":351},"Given the broad range of potential causes of complications from obstetric trauma, in addition to recommendations listed above, we recommend conducting clinical and system reviews to identify latent causes and determine appropriate recommendations.",{"type":15,"attrs":9403,"content":9404},{"textAlign":775},[9405],{"text":778,"type":351},{"type":780,"attrs":9407,"content":9408},{"order":782},[9409,9415,9421,9427],{"type":441,"content":9410},[9411],{"type":15,"attrs":9412,"content":9413},{"textAlign":53},[9414],{"text":790,"type":351},{"type":441,"content":9416},[9417],{"type":15,"attrs":9418,"content":9419},{"textAlign":53},[9420],{"text":797,"type":351},{"type":441,"content":9422},[9423],{"type":15,"attrs":9424,"content":9425},{"textAlign":53},[9426],{"text":804,"type":351},{"type":441,"content":9428},[9429],{"type":15,"attrs":9430,"content":9431},{"textAlign":53},[9432],{"text":811,"type":351},{"_uid":813,"items":9434,"title":858,"component":859,"description":9459},[9435,9441,9447,9453],{"_uid":835,"image":9436,"title":1629,"component":822,"description":9438},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":9437,"is_external_url":285},{},{"type":12,"content":9439},[9440],{"type":15},{"_uid":827,"image":9442,"title":830,"component":822,"description":9444},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":9443,"is_external_url":285},{},{"type":12,"content":9445},[9446],{"type":15},{"_uid":816,"image":9448,"title":821,"component":822,"description":9450},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":9449,"is_external_url":285},{},{"type":12,"content":9451},[9452],{"type":15},{"_uid":843,"image":9454,"title":838,"component":822,"description":9456},{"id":818,"alt":16,"name":16,"focus":16,"title":16,"source":16,"filename":819,"copyright":16,"fieldtype":283,"meta_data":9455,"is_external_url":285},{},{"type":12,"content":9457},[9458],{"type":15},{"type":12,"content":9460},[9461],{"type":15,"attrs":9462,"content":9463},{"textAlign":53},[9464],{"text":1657,"type":351},{"_uid":868,"items":9466,"title":890,"component":641,"description":11095},[9467,9820,10014,10140,10328,10682,10868,10955],{"_uid":871,"title":872,"ctaLeft":9468,"ctaRight":9469,"component":603,"columnLeft":9470,"columnRight":9505},[],[],{"type":12,"content":9471},[9472,9476,9489,9497],{"type":15,"attrs":9473,"content":9474},{"textAlign":53},[9475],{"text":1790,"type":351},{"type":438,"content":9477},[9478],{"type":441,"content":9479},[9480],{"type":15,"attrs":9481,"content":9482},{"textAlign":53},[9483,9487],{"text":9484,"type":351,"marks":9485},"A03",[9486],{"type":677},{"text":9488,"type":351},": Obstetric Trauma",{"type":15,"attrs":9490,"content":9491},{"textAlign":53},[9492,9495],{"text":5405,"type":351,"marks":9493},[9494],{"type":677},{"text":9496,"type":351},": Third- or fourth-degree perineal lacerations or other obstetric injuries to pelvic organs during a non-instrumented vaginal delivery identified during the delivery episode of care.",{"type":15,"attrs":9498,"content":9499},{"textAlign":53},[9500,9503],{"text":7825,"type":351,"marks":9501},[9502],{"type":677},{"text":9504,"type":351},": Refer to D03: Obstetric Trauma for obstetric trauma during an instrument-assisted vaginal delivery.",{"type":12,"content":9506},[9507,9514,9532,9547,9562,9577,9592,9607,9622,9637,9652,9667,9682,9697,9714,9729,9744,9759,9774,9789,9797,9803],{"type":15,"attrs":9508,"content":9509},{"textAlign":53},[9510,9513],{"text":2708,"type":351,"marks":9511},[9512],{"type":677},{"text":2712,"type":351},{"type":15,"attrs":9515,"content":9516},{"textAlign":53},[9517,9521,9523,9526,9528],{"text":9518,"type":351,"marks":9519},"O70.201*",[9520],{"type":677},{"text":9522,"type":351},": Identified as diagnosis type (M), (1), (2), (W), (X) or (Y) ",{"text":3968,"type":351,"marks":9524},[9525],{"type":677},{"text":9527,"type":351},"O10–O16, O21–O26, O28–O37, O40–O46, O48.–, O60–O75, O85–O92, O95.– or O98–O99 with a sixth digit of 1 or 2 or Z37.– ",{"text":9529,"type":351,"marks":9530},"on the same 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condition",{"type":15,"attrs":9900,"content":9901},{"textAlign":53},[9902,9906],{"text":9903,"type":351,"marks":9904},"O70.281",[9905],{"type":677},{"text":9907,"type":351},": Third degree perineal laceration during delivery, other specified type, delivered, with or without mention of antepartum condition",{"type":15,"attrs":9909,"content":9910},{"textAlign":53},[9911,9915],{"text":9912,"type":351,"marks":9913},"O70.291",[9914],{"type":677},{"text":9916,"type":351},": Third degree perineal laceration during delivery, unspecified type, delivered, with or without mention of antepartum condition",{"type":15,"attrs":9918,"content":9919},{"textAlign":53},[9920,9923],{"text":9611,"type":351,"marks":9921},[9922],{"type":677},{"text":9924,"type":351},": Fourth degree perineal laceration during delivery; delivered with or without mention of antepartum 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ACOG Practice Bulletin No. 205: Vaginal Birth After Cesarean Delivery. ",{"text":11294,"type":351,"marks":11311},[11312],{"type":1417},{"text":11314,"type":351},". 2019;133(2):e110-e127. doi: ",{"text":11316,"type":351,"marks":11317},"10.1097/AOG.0000000000003078",[11318],{"type":398,"attrs":11319},{"href":11320,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},"https://doi.org/10.1097/AOG.0000000000003078",{"type":15,"attrs":11322,"content":11323},{"textAlign":775},[11324,11326,11330,11332],{"text":11325,"type":351},"Andersen MM, Thisted DLA, Amer-Wahlin I, Krebs L. Can Intrapartum Cardiotocography Predict Uterine Rupture among Women with Prior Caesarean Delivery?: A Population Based Case-Control Study. ",{"text":11327,"type":351,"marks":11328},"PLoS One",[11329],{"type":1417},{"text":11331,"type":351},". 2016;11(2):e0146347. doi: ",{"text":11333,"type":351,"marks":11334},"10.1371/journal.pone.0146347",[11335],{"type":398,"attrs":11336},{"href":11337,"uuid":53,"anchor":53,"custom":53,"target":53,"linktype":598},"https://doi.org/10.1371/journal.pone.0146347",{"type":15,"attrs":11339,"content":11340},{"textAlign":775},[11341,11343,11348],{"text":11342,"type":351},"BC Patient Safety & Quality Council. Quality Awards 2009. Managing Obstetrical Risk Efficiently (MOREOB): Northern Health. 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